The 2015 Comprehensive Needs Assessment Memphis Transitional

Transcription

The 2015 Comprehensive Needs Assessment
Memphis Transitional Grant Area (TGA)
Memphis Ryan White Program
Developed by:
The Priorities and Comprehensive Planning Committee
HIV-Care and Prevention Group
__________________________________________________________________
As submitted to the Federal Health Resources Services Administration (HRSA) by the Memphis Area
Ryan White Planning Council and the Memphis Ryan White Part A Program Office in compliance with
Ryan White HIV/AIDS Treatment Extension Act of 2009.
TABLE OF CONTENTS
Acknowledgements…………………………………………………………......………………..
List of Figures/Tables………........................................................................................................
Introduction & Background…………………...………………………………………………..
Section I. Epidemiologic Profile……....….................................................................................
1. Socio-demographic Characteristics of the Memphis TGA
2. Scope of the HIV/AIDS Epidemic in the Memphis TGA
3. HIV-Related Co-Morbidities and Social Factors
4. Indicators of HIV Risk among Disproportionately Impacted Populations
5. HIV Care Continuum for FY 2015
Section II. Assessment of Service Needs and Gaps…………………………………...…...…
Consumer Survey
Section III. Resource Inventory…………………………………………………….…………
Section IV. Provider Capacity and Capabilities…………..…………………………………
Provider Survey
Section V. Estimation and Assessment of Unmet Need…………………………….………..
Conclusions and Recommendations…………..………………………….……………………
References……………………………………………………………………………………….
Appendices…………………………………………………………………..…………………..
A. Consumer Survey
B. Focus Group Questions
C. Resource Inventory
D. Provider Survey
2
ACKNOWLEDGEMENTS
The 2015 Comprehensive Needs Assessment includes the work of many individuals committed
to improving the HIV system of care in the Memphis Transitional Grant Area (TGA). We wish
to thank all those that offered their time, talent, input and knowledge to this effort. In
appreciation of their commitment to the continuous improvement in our system of HIV care, we
wish to acknowledge past and current members of the Priorities and Comprehensive Planning
Committee.
Andrea Williams
Brandon Williams
Derrick Newby
Donald Worth
Mary Jackson
Nicole Gottier
Renae Taylor
Robert Wilkins
Roslyn McGhee
Tonya King
We would also like to thank members of the HIV Care and Prevention Group (Full and Alternate
members as of August 2015):
Shearlean Dowell, CoChair
Christopher Mathews, CoChair
Denford Galloway,
Secretary
Darnell Atkins
Elizabeth Anderson
Dominque Banks
Lisa Brisendine
Rachel Brooks
Melanie Copeland
Lee Goins
Nicole Gottier
Anthony Hardaway
Fran Harper
Mardrequs Harris
Mary Jackson
Jay Johnson
Erica Jones
Tonya King
Michael LaBonte
Elise McNutt
Joseph Mitchell
Derrick Newby
Elgin Prachett
Trevor Rawls
Cedric Robinson
Andrea Stubbs
Renae Taylor
Wendell Wainwright
Edward Wiley
Robert Wilkins
Donald Worth
Eric Wilson
Melissa Wright
We would like to acknowledge the following organizations for their contribution to the 2015
Comprehensive Needs Assessment:
Aaron E. Henry Community Health Services
Center, Inc.
Adult Special Care Center/Regional One
Christ Community Health Services
Cocaine Alcohol Awareness Program
East Arkansas Family Health Center
Friends for Life
Hope House
Memphis VA Medical Center
Peabody House
Sacred Heart Southern Missions
Shelby County Health Department
St. Jude Children’s Research Hospital
Tennessee Department of Health, HIV/STD
Program
3
In addition, we would like to thank the Grantee’s office and the members of the research team:
Memphis Ryan White Program Staff:
Jennifer Marshall Pepper, Administrator
Nycole Alston, Planning Group Manager
Fatimah Stout, Clerical Specialist
Steve Overman, Data Analyst
Shelby County Health Department Staff:
David Sweat, Chief of Epidemiology
Suliman Aizezi, HIV/STD Epidemiologist
Community Research Assistants:
Denford Galloway, Denford Galloway Enterprise
DeMarcus Taylor, University of Memphis Student
Donya Ahmadian, University of Memphis Student
Emily White, University of Memphis Student
Rashmi Parveen, University of Memphis Student
Taylor Dargie, University of Memphis Student
4
LIST OF FIGURES/TABLES/MAPS
Figure 1-1.
Figure 1-2.
Figure 1-3.
Figure 1-4.
Figure 2-1.
Figure 2-2.
Figure 2-3.
Figure 2-4.
Figure 5-1.
Figure 5-2
Figure 5-3.
Figure 5-4.
Figure 5-5.
Figure 5-6.
Figure 5-7.
Figure 5-8.
Figure 6-1.
Figure 6-2.
Figure 6-3.
Figure 6-4.
Figure 6-5.
Figure 7-1.
Figure 7-2.
Figure 7-3.
Figure 7-4.
Figure 7-5.
Figure 10-1.
Figure 10-2.
Figure 10-3.
Figure 10-4.
Figure 10-5.
Figure 10-6.
Map 1-1.
Map 1-2.
TGA Residents Not Covered by Health Insurance by Sex, 2013
TGA Residents Not Covered by Health Insurance by Race/Ethnicity, 2013
TGA Residents Not Covered by Health Insurance by Age Group, 2013
TGA Residents below the Poverty Level by Educational Status, 2013
Rates and Ranks of New HIV Infection by Metropolitan Statistical Area, United States,
2013
Rates and Ranks of New AIDS Diagnosis by Metropolitan Statistical Area, United
States, 2013
Trends of Persons Living with HIV/AIDS in the Memphis TGA, 2009 – 2014
New HIV, AIDS, and Death Cases, Three Year Rolling Average, West TN 3 Counties,
1984 - 2014
Proportions of Population and Newly Diagnosed HIV Cases, Memphis TGA, 2014
New HIV, New AIDS, and Late HIV Diagnosis by age group, West TN, 2014
Rates of Newly Diagnosed HIV Case (per 100,000 persons) by age group in United
States and Memphis TGA, 2013
Babies born with HIV infected mothers by Race/Ethnicity, three Tennessee counties,
2010 – 2014
Race and Ethnicity of babies born with HIV infected mothers by Race/Ethnicity, three
Tennessee counties, 2010 – 2014
Trends of Perinatal HIV infection, West Tennessee Counties, 2008 – 2012
Cumulative congenital syphilis cases by Race/Ethnicity, the three Tennessee Counties,
2010 – 2014
Rates of Newly diagnosed HIV by Race/Ethnicity, in the Memphis TGA, 2010 – 2014
HIV Care Continuum in the West TN three Counties, 2014
Ryan White HIV/AIDS Program clients by County, Memphis TGA, 2014
Continuum of HIV Care among Ryan White HIV/AIDS Program clients, Memphis
TGA, 2014
Antiretroviral Therapy (ART) among Ryan White HIV/AIDS Program clients,
Memphis TGA, 2014
Viral Load Suppression among Ryan White HIV/AIDS Program clients, Memphis
TGA, 2014
Sexual Orientation of Survey Respondents
Sex at birth of Survey Respondents
Gender identity of Survey Respondents
Race of Survey Respondents
Time since HIV Diagnosis of Survey Respondents
Unmet Need among the PLWHA in the Memphis TGA, in 2014
Unmet Need among the PLWHA, West TN three Counties, 2009 – 2014
Linkage to Care and Unmet Need in the West Tennessee, 2007-2014
Number of Tests and New HIV Diagnosis, Memphis TGA, 2010 – 2014
The Continuum of Engagement in Care for Persons Living with HIV/AIDS
Late HIV Diagnosis in Shelby, Fayette, and Tipton Counties in Tennessee, 2009 – 2014
Geographical location of the Memphis TGA
Memphis TGA County Populations, 2013
5
Map 2-1.
Map 2-2.
Map 2-3.
Map 2-4.
Map 2-5.
People Living With HIV/AIDS by Counties in the Memphis TGA, 2014
Rates (per 100,000 persons) of PLWHA in Shelby County, Tennessee, as of 2014
Persons Living with HIV/AIDS by Zip Code, Memphis TGA, 2014
HIV Disease Incidence in the Memphis TGA by County, 2014
Rates (per 100,000 persons) of HIV/AIDS Prevalence and Incidence, Shelby County,
2014
Map 3-1.
Rates (per 100,000) of HIV/AIDS Prevalence, Incidence, and Co-Infected P&S
Syphilis, Shelby County, 2014
Map 10-1. Estimated Number of PLWH Out of Care by Zip Code, Shelby County, 2011
Table 1-1. Memphis TGA Population by Race/Ethnicity, 2013
Table 1-2. Memphis TGA Population by Sex and Age, 2013
Table 1-3. Educational Attainment of TGA Residents age 25 Years & Older by Sex, 2013
Table 1-4. TGA Residents below the Poverty Level by Selected Demographics, 2013*
Table 2-1. Prevalence of HIV or AIDS, Demographic characteristics by Sex, Memphis TGA, as of
2014
Table 2-2. Persons Living with HIV/AIDS by Geographic Residence and Demographics/Risk
Exposure Category, Memphis TGA, 2014
Table 2-3. Prevalence of AIDS, Demographic characteristics by Sex, Memphis TGA, as of 2014
Table 2-4. Newly Diagnosed HIV Disease Cases by County, Memphis TGA, 2010-2014
Table 2-5. Proportions of new HIV Cases by demographic characteristics, Memphis TGA, 20102014
Table 2-6. New HIV Disease Case Rates by Demographics, Memphis TGA, 2010-2014
Table 2-7. New AIDS diagnoses by region in Memphis TGA, 2010 - 2014
Table 2-8. Rates of Newly Diagnosed AIDS cases (per 100,000 persons) by Demographic
Characteristics, Memphis TGA, 2010 - 2014
Table 2-9. Late HIV Diagnoses in the West Tennessee three Counties, 2010 – 2014
Table 2-10. Deaths in Persons with HIV infection, by Demographics and Risk characteristics,
Memphis TGA, 2010 - 2013
Table 3-1. STD Incidence Rates (per 100,000 persons) in Memphis MSA and U.S. MSA total,
2009 – 2013
Table 3-2. Chlamydia Incidence Rates (per 100,000 persons) of reported cases in Memphis, TNMS-AR and U.S.
MSA, 2009 - 2013
Table 3-3. Chlamydia and Gonorrhea Rates among Adolescents ages 15-19 Years, Shelby County
and Tennessee, and National, 2014
Table 3-4. STD Co-Morbidities Reported among Persons Living with HIV Disease and the
General Population, Shelby County TN, 2014
Table 3-5. Tuberculosis Cases and Rates in MSAs and Shelby County in 2013
Table 5-1. Newly diagnosed HIV Cases among the Black Males in the West Tennessee three
counties, 2014*
Table 5-2. Sexual Health Responses from the Youth Risk Behavior Survey among 9-12th Graders
in Memphis and the Nation, 2013
Table 5-3. Newly diagnosed HIV Cases among the Black Females in the three Tennessee counties,
2014*
Table 6-1. Ryan White HIV/AIDS Program clients, Memphis TGA, 2014
Table 6-2. Continuum of HIV Care Definitions (HRSA)
6
Table 6-3.
Table 7-1.
Table 7-2.
Table 7-3.
Table 7-4.
Table 7-5.
Table 7-6.
Table 7-7.
Table 7-8.
Table 7-9.
Table 8-1.
Table 8-2.
Table 9-1.
Table 9-2.
Table 9-3.
Table 9-4.
Table 9-5.
Table 9-6.
Table 9-7.
Table 9-8.
Table 9-9.
Table 9-10.
Table 9-11.
Table 9-12.
Table 9-13.
Table 9-14.
Table 9-15.
Table 9-16
Table 9-17.
Table 10-1.
Table 10-2.
Table 10-3.
Table 10-4.
Table 10-5.
Table 10-6.
Table 10-7.
Engagement of Care and Achievement of Viral Load Suppression among the Ryan
White part A Clients, Memphis TGA, 01/01/2014 – 12/31/2014
Age Groups of Consumer Respondents
Relationship Status of Survey Respondents
Job situation of Survey Respondents
Educational Attainment of Survey Respondents
Core Service Utilization of Survey Respondents
Support Service Utilization of Survey Respondents
Barriers of Survey Respondents
Cultural Competency per consumer respondents
Medication Adherence of Survey Respondents
Focus Group Logistics.
Characteristics of Focus Group Participants
Provider Survey Response in the Memphis TGA
Provider Role Completing Survey
Core Medical Services rendered by the respondent’s organization
Supportive Services rendered by the respondent’s organization
Age Range of Respondents
Sexual Orientation of Respondents
Sex at Birth of Respondents
Race of Respondents
Time rendering care to PLWHA
Programming Assessment
Linkage method efficacy
Retention Method Efficacy
Cultural Competency Self-Reflection
Providers’ thoughts on consumer needs
Improvement suggestions
Barriers to Care
Assessment of Provider Knowledge of Prevention Programs
Residency of PLWHA out of Medical Care by county, Memphis TGA, 2014
Unmet Need Framework in the Memphis TGA, in 2014
Number of cases and percentages among the PLWHA out of Medical Care by
Demographic Characteristics, West Tennessee three Counties, 2014
HIV tests conducted by counties in the Memphis TGA, 2014*
HIV Tests at Publicly Funded Test Sites in Shelby County, 2014
HIV Tests Conducted by demographic characteristics, Shelby County Health
Department, 2014
Newly diagnosed positive HIV test events, Memphis TGA, in 2014
7
SECTION I. EPIDEMIOLOGICAL PROFILE
Introduction and background
Memphis TGA Area
Part A of the Ryan White HIV/AIDS Treatment Extension Act of 2007 provides assistance to
Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs)—locales that are
most severely affected by the HIV/AIDS epidemic. These critical funds allow eligible program
areas to develop and enhance access to a comprehensive continuum of high quality, community
based care for low-income persons living with HIV/AIDS (PLWHA). The Memphis Transitional
Grant Area (TGA) strives to maintain a comprehensive continuum of care with prioritized core
medical services and health – related support services that allow PLWH to obtain optimal
medical treatment for HIV (the human immunodeficiency virus) infection.
The Memphis TGA encompasses eight counties from three states Shelby, Tipton and Fayette
counties in Tennessee, DeSoto, Marshall, Tate and Tunica counties in Mississippi, and
Crittenden County in Arkansas. These counties ranged in population from 10,000 to 937,000
persons as of 2013. The largest proportion of the Memphis TGA population resides in Shelby
County (70.5%), followed by DeSoto County in Mississippi (12.5%), and Crittenden County in
Arkansas (3.8%) (Map 1-1). Approximately half of the TGA population is White (45%) and half
of them are Black/African American (44%), and 5% are Hispanic (Table 1-1).
HIV/AIDS in the Memphis TGA
According to the Centers for Disease Control and Prevention, 2013 (Volume 25)4, the Memphis
metropolitan statistical area (MSA) ranks seventh in the nation among all metropolitan statistical
areas for the rate of new HIV cases and ranked first for the rate of newly diagnosed AIDS cases.
In Tennessee, Shelby County ranks first among all counties for the rate of newly diagnosed HIV
cases, first in the state for the number of new people diagnosed with HIV/AIDS as well as for the
number of persons living with HIV/AIDS (PLWHA) in 2014. Almost 40% of PLWHA in
Tennessee are living in Shelby County.
As of 2014, 86% of PLWHA in the Memphis TGA resided in Shelby County. Of the 7,292
PLWHA, 82% were African Americans, 13% were not-Hispanic Whites, 3% were
Hispanic/Latinos, and 2% are Other/Not Identified Race/Ethnic groups.
In 2014, 324 new cases of HIV/AIDS were diagnosed in the Memphis TGA. Males and
Blacks/African‐Americans had the highest rates of new infection. Men who have sex with men
(MSM) and heterosexual contact accounted for the majority of attributed risk among new cases.
The majority of new infection burdens were on adolescents and young adults aged 15-34 years
old. Overall, the rates of new HIV cases in the Memphis TGA are declining, while the rates of
new AIDS cases are on the rise.
Also in 2014, almost half (49%) of the 7,927 PLWHA in the Memphis TGA had progressed to
AIDS. Trends among PLWHA mirror those among the newly‐diagnosed: men and
8
Blacks/African‐Americans had the highest rates and MSM and heterosexual contact accounted
for the majority of attributed risk.
The mortality rate associated with HIV/AIDS in the Memphis TGA has remained relatively
stable. Most recent estimates place the rate of HIV/AIDS death at 10.5 per 100,000 cases, or 139
deaths in 2014. Rates of death among PLWHA were highest among men, Blacks/African‐
Americans, MSM, and heterosexual contacts. The proportion of mortality shifted from the
younger age group to older age group between 2010 and 2014. This is likely due to the
improvement of HIV care measures in the Memphis TGA.
The Continuum of HIV care shows the Memphis TGA can still improve for each of the
sequential stages of care. Ryan White part A clients show a higher proportion retained in care,
prescribed ART, and viral load suppression compare to those of all persons living with HIV
infection in the Memphis TGA. The older age groups (aged 34 years and older) achieved higher
levels of viral load suppression compare to the adolescents and young adults aged 15-24 years
old. In 2014, among all persons living with HIV including those unaware of their HIV infection
in Memphis TGA, more than half of the infected individuals did not achieve viral load
suppression. This group account for more than 90% of new HIV infections17.
This comprehensive needs assessment, commissioned by the Memphis TGA Ryan White
Planning Group, the HIV Care and Prevention Group (H-CAP) intends to: (1) describe key
characteristics of PLWH in the Memphis TGA and populations disproportionately affected by
HIV; (2) provide an overview of current services offered through the Ryan White Part A
program and highlight the potential implications of policy and funding shifts for the provision of
those services; (3) summarize trends in linkage to and retention in HIV primary care and
describe the need for and utilization of supportive services that can facilitate linkage to and
retention in HIV primary care; and (4) discuss Ryan White Part A clients’ experiences with
service provision and perceptions of quality of care and highlight barriers to and facilitators of
care for PLWH in the Memphis TGA. By describing the current body of knowledge, this review
aims both to shed light on remaining information gaps and to provide a foundation for
recommendations that can be used by members of the Planning Council to set service priorities
and allocate resources in a way that best meets the needs of the Ryan White Part A client
population.
1. Socio Demographic Characteristics of Memphis TGA
Geographic Location of the Memphis TGA
The Memphis TGA encompasses eight counties from three states Shelby, Tipton and Fayette
counties in Tennessee, DeSoto, Marshall, Tate and Tunica counties in Mississippi, and
Crittenden County in Arkansas. The orange shaded region represents current geographical
location of the Memphis TGA in the Tri-State Area (Map 1-1). The Memphis Metropolitan
Statistical Area (MSA), which mirrors the boundaries of the Memphis TGA, is populated by
more than 1.3 million people with 4,578 square miles of land area1.
9
Map 1-1. Geographical location of the Memphis TGA
Data Source: ArcGIS; U.S. Census Bureau, 2011-2013 3-Years American Community Survey
County Populations
In the Memphis TGA, the counties ranged in population from 10,000 to 937,000 persons as of
2013. The largest proportion of the Memphis TGA population reside in Shelby County (70.5%),
followed by DeSoto County in Mississippi (12.5%) and Crittenden County in Arkansas (3.8%)
(Map 1-2). Approximately half of the TGA population are Non-Hispanic Whites (45%) and half
of them are Black/African Americans (46%), and 5% are Hispanic/Latinos (Table 1-1).
Although Shelby County occupies only 16.7% of land area in the TGA (Map 1-2), the largest
proportion (70.5%) of the Memphis TGA population reside in Shelby County; followed by
DeSoto County in Mississippi (12.6%) and Crittenden County in Arkansas (4.6%) .
Map 1-2. Memphis TGA County Populations, 2013
Data Source: U.S. Census Bureau, 2011-2013 3-Year American Community Survey.
10
According to the U.S. Census Bureau, the total population in the TGA has increased over the
past 10 years by almost 35%. While some counties have remained relatively stable in growth,
others have shown significant increases. DeSoto County has increased in population by 50%
over the past decade, while Fayette County has increased by 33%. Crittenden County population
has remained unchanged, and Shelby County has increased by approximately 3% 1.
Race and Ethnicity
The 2013 American Community Survey estimates 45.5% of Memphis TGA residents are NonHispanic Whites, 45.8% are Non-Hispanic Black/African American, and 5.1% are
Hispanic/Latinos (Table 1-1). Approximately 3% of the remaining TGA population is comprised
of other races, including Asians (1.8%), American Indian/Alaskan Natives (0.2%) and persons
reporting two or more races (1.1%).
The racial/ethnic distribution of Memphis TGA residents varies by county (Table 1-1). Over half
of Shelby County residents are Non-Hispanic Black/African American (52.3%), while almost
6% are Hispanic/Latinos. The majority of residents are Non-Hispanic Whites in the rural
counties of Fayette, in Tennessee, Tipton in Tennessee, and Tate in Mississippi, while Tunica
County in Mississippi is predominantly Non-Hispanic Blacks. The proportion of Non-Hispanic
Whites and Black/African Americans residents in Crittenden County in Arkansas is more evenly
distributed. DeSoto County in Mississippi is primarily comprised of Non-Hispanic White
residents (69%), but the second largest Hispanic population is also located in this county (5.0%).
Table 1-1. Memphis TGA Population by Race/Ethnicity, 2013
Total
County
Shelby
Tipton
Fayette
Crittenden
DeSoto
Marshal
Tate
Tunica
White,
Black,
Non-Hispanic
Non-Hispanic
N
%
N
%
604,183 45.43% 608,665 45.77%
Hispanic
or Latino
N
%
68,000 5.11%
N
49,083
%
3.69%
355193
47,007
26,206
22,418
114,396
17,733
18,770
2,460
54722
1,448
944
1,097
8,186
1,224
143
236
37,715
2,276
743
1,318
5,301
486
1,052
192
4.02%
3.70%
1.93%
2.63%
3.19%
1.33%
3.69%
1.79%
37.88%
76.43%
67.94%
44.73%
68.86%
48.45%
65.77%
22.96%
490118
10,770
10,682
25,284
38,249
17,159
8,575
7,828
52.27%
17.51%
27.69%
50.45%
23.02%
46.88%
30.05%
73.05%
5.84%
2.35%
2.45%
2.19%
4.93%
3.34%
0.50%
2.20%
Others
Sex and Age
The American Community Survey (ACS) 2011-2013 three - year estimate shows that 48% of
Memphis TGA residents (638,803) were male and 52% were female (691,128). The age
distribution for males and females in the Memphis TGA is similar. However, a greater
proportion of females (12.6%) were aged 65 and older compared to males (9.8%). This shows
that average life span of the female population is relatively longer (3%) than male population.
11
More than one-third (35.8%) of the population is less than 25 years of age (Table 1-2). The
median age was 35 years.
Table 1-2. Memphis TGA Population by Sex and Age, 2013
Males
Total
Age Group
(Year)
0-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65+
N
638803
94416
50756
49906
47073
87242
84874
87246
74471
62367
Females
%
48.03%
14.78%
7.95%
7.81%
7.37%
13.66%
13.29%
13.66%
11.66%
9.76%
N
691,128
90281
49618
47460
48117
94194
91550
97305
85514
87046
%
51.97%
13.06%
7.18%
6.87%
6.96%
13.63%
13.25%
14.08%
12.37%
12.59%
Total
N
1,329,931
184545
100113
97052
94782
181059
175890
184479
160696
149170
%
100%
13.88%
7.53%
7.30%
7.13%
13.61%
13.23%
13.87%
12.08%
11.22%
Health Insurance
More males (17.0%) were uninsured as compared to females (14.1%) among the residents of
Memphis TGA. The largest percentages of uninsured males and females were among the
residents of Tunica County in north Mississippi (Figure 1-1). Minorities also represent higher
percentages of persons not covered by health insurance 18% of Black/African Americans and
35% of Hispanics were not covered as compared to 13% of Non-Hispanic Whites in the
Memphis TGA (Figure 1-4).
Figure 1- 1. TGA Residents Not Covered by Health Insurance by Sex, 2013
12
Figure 1-2. TGA Residents Not Covered by Health Insurance by Race/Ethnicity, 2013
Health insurance coverage among the age groups varies by county in the Memphis TGA (Figure
1- 3). At the end of 2013, 22% of all adults aged 18-64 years in the Memphis TGA do not have
health insurance coverage, while 6% of children and adolescents and less than 1% of adults aged
65 years and older do not have health insurance More than 33% of adults aged 18 to 64 years are
not covered by health insurance in Tunica County, Mississippi, Crittenden County, Arkansas,
(24%), and Shelby County, Tennessee (22.4%). The largest percentage of children and
adolescents not covered by insurance was reported in DeSoto County, Mississippi (9.0%),
followed by Shelby County, Tennessee (7%).
Figure 1- 3. TGA Residents Not Covered by Health Insurance by Age Group, 2013
13
Educational Attainment
In the Memphis TGA, approximately 15% of persons aged 25 years old and older have not
achieved a high school diploma (Table 1-3). A larger percentage of adult females have attained a
high school graduate degree or higher (87.3%) than males (84.2%). Approximately, 26.4% of all
Memphis TGA residents have obtained a bachelor’s degree or higher.
Table 1-3. Educational Attainment of TGA Residents age 25 Years & Older by Sex, 2013
Total
Less than 9th grade
9th to 12th grade, no diploma
High school graduate (includes equivalency)
Some college, no degree
Associate's degree
Bachelor's degree
Graduate or professional degree
Total
851,838
4.76%
9.39%
28.76%
23.96%
6.62%
17.09%
9.33%
Male
396,405
5.37%
13.11%
30.19%
22.74%
5.53%
16.84%
8.82%
Female
455,433
4.19%
8.44%
27.58%
25.02%
7.59%
17.42%
9.68%
Poverty Level
Approximately 20% of all residents in the Memphis TGA are living below the poverty level
(Table 1-4). Children and adolescents are disproportionately impacted by poverty;
approximately 30% of all residents under the age of 18 years are living in poverty.
Table 1-4. TGA Residents below the Poverty Level by Selected Demographics, 2013*
Total Population
Age
Under 18 years
18 to 64 years
65 years and over
Sex
Male
Female
Race/Ethnicity
White, Not Hispanic
Black, Not Hispanic
Hispanic or Latino
Population Poverty Status is
determined
# of People Below
Poverty
% of People Below
Poverty
1,304,651
255,928
19.62%
340,817
818,508
139,694
101,908
137,518
15,808
29.90%
16.80%
11.32%
624,154
680,497
112,773
143,331
18.07%
21.06%
628,118
596,728
53,784*
59,847
176,825
20,767*
9.53%
29.63%
38.6%*
*Shelby County data only, data was unavailable for other counties in the TGA
Twenty-one percent of all Memphis TGA females are living below the poverty level, as
compared to 18% of males. Minorities are also largely impacted by high rates of poverty; almost
30% of Black/African American residents. In Shelby county 39% of Hispanic/Latino residents
are living below the poverty level.
14
Effects of Education attainment on Poverty level
As educational attainment increases, the percentage of poverty decreases. Among the TGA
residents aged 25 years and older, one third of them (33%) are living in below the poverty level
who did not graduate high school compared with 4.4% living in below the poverty level who
earned Bachelor’s or higher degree (Figure 1-4).
Figure 1-4. TGA Residents below the Poverty Level by Educational Status, 2013
2. Scope of the HIV/AIDS Epidemic in the Memphis TGA
Introduction
Health Resources and Services Administration (HRSA) requires Ryan White programs to
compile an epidemiological profile that describes HIV/AIDS incidence, prevalence, trends and
population changes. The HIV/AIDS epidemic has affected people of all gender, age and
racial/ethnic groups in the Memphis TGA. This effect, however, has not been the same for all
groups. The Shelby County Health Department Epidemiology Section was consulted to collect
data from several sources to create the overall Memphis TGA epidemiological profile presented
in this report.
All epidemiological data presented in this section were exported from the Tennessee Enhanced
HIV/AIDS Reporting System (eHARS) and Ryan White CAREWare System and requested from
the Shelby County Health Department, the Tennessee Department of Health, the Mississippi
Department of Health and the Arkansas Department of Health. Data were drawn from the U.S.
Census1, the 2012 Memphis TGA Ryan White HIV/AIDS Comprehensive Care Needs
Assessment2, the 2011 Ryan White Housing Needs Assessment3, 2013 Ryan White Data
Reports, and other sources as referenced.
15
While the number of new infections in the nation has remained relatively stable, newly
diagnosed cases in the Memphis TGA have shown overall decline in the past five years (Figure
2-6); however, the TGA incidence rate remains above the national figures. According to the
Centers for Disease Control and Prevention (CDC) 2013 HIV Surveillance Report, the Memphis
TGA ranked seventh in the nation for the rate of new HIV infections and first in the nation for
newly diagnosed AIDS cases (stage 3 HIV infection) (Figure 2-1) among the metropolitan
statistical areas (MSAs) of residence in the United States in 20134.
Figure 2-1. Rates and Ranks of New HIV Infection by Metropolitan Statistical Area,
United States, 2013
Data Source: Centers for Disease Control and Prevention (2014). HIV Surveillance Report, 2013.
http://www.cdc.gov/hiv/library/reports/surveillance/2013/surveillance_Report_vol_25.html
16
Figure 2-2. Rates and Ranks of New AIDS Diagnosis by Metropolitan Statistical Area,
United States, 2013
Data Source: Centers for Disease Control and Prevention (2014). HIV Surveillance Report, 2013.
The estimated new HIV infection rate (30.8 per 100,000 population) in the Memphis MSA was
more than two times higher than the estimated new HIV infection rate (15.0 per 100,000
population), and the new AIDS diagnosis rate (31.3 per 100,000 population) in the Memphis
MSA was almost 4 times higher than the new AIDS diagnosis rate (8.5 per 100,000 population)
among all MSAs in the United States in 2013.
The estimated HIV and AIDS prevalence rate in the Memphis MSA5 respectively (539.5 and
240.5 per 100,000 population) were approximately two times greater than the estimated HIV
prevalence rate and 1.5 times greater than the AIDS prevalence rate in the United States MSA
(293.9 and 163.5 per 100,000 population) respectively in 2013.
HIV and AIDS Prevalence (PLWHA) in the Memphis TGA as of 2014
As new HIV disease cases are being diagnosed each year and anti-retroviral treatment has
become increasingly available, the prevalence of persons living with HIV/AIDS in the Memphis
TGA continues to rise. As detailed in Map 2-1, a total of 7,297 individuals were estimated to be
currently living with HIV disease at the end of 2014. The Memphis TGA accounts for the largest
number of persons living with HIV/AIDS among the TGAs in Tennessee, and approximately
86% of all PLWHA in the Memphis TGA reside in Shelby County. DeSoto County in
Mississippi accounts for the second largest PLWHA population (5.5%) followed by Crittenden
County in Arkansas (3.4%).
17
Map 2-1. People Living With HIV/AIDS by Counties in the Memphis TGA, 2014
Source: Shelby County Health Department, Epidemiology Section (2)Mississippi Department of
Health, STD/HIV Office (3) Arkansas Departme nt of Health, HIV/AIDS Registry Section.
Of the 7,279 individuals estimated to be currently living with HIV disease at the end of 2014,
49% (n=3,576) of these individuals were classified as AIDS (Figure 2-3). The overall
percentage of persons living with HIV infection stage 3 (AIDS) has gradually increased from
46% (n=2,983) in 2011 to 49% (n=3,576) in 2014. This is due to the effective care, treatment,
and lower number of deaths among the PLWHA than new HIV cases each year. The overall
percentages of People living with HIV not AIDS are steadily decreased from 54% (n=3,459) in
2011 to 51% (n=3,721) in 2014. This decrease is partly due to overall decreasing of HIV
incidence in Memphis TGA 429 new cases in 2011 to 324 new case in 2014 (Table 2-4).
18
Figure 2-3. Trends of Persons Living with HIV/AIDS in the Memphis TGA, 2009 – 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, AR; *: Preliminary data subject to change
Almost 68% of people living with HIV or AIDS in the Memphis TGA are male. The majority is
Non-Hispanic Black (82%), followed by Non-Hispanic White (13%) and 3% Hispanic/Latino.
Almost 47% of persons living with HIV or AIDS were 45 years of age and older at the end of
2014. 56% of all females living with HIV or AIDS are within the child-bearing range of 13 to 44
years of age (Table 2-1).
40% of all PLWHA account their risk exposure to MSM contact, 31% to heterosexual contact,
24% have an unidentified risk transmission exposure, 3% to intravenous drug use (IDU), 2%
MSM/IDU, and 1% through perinatal exposure. A higher percentage of females living with HIV
or AIDS are non-Hispanic Black (87%) compared to males (79%). The vast majority of HIVinfected women have heterosexual risk (68%), IDU (4%) and 25% have an unidentified risk
exposure. Among males, 58% of the cases are attributed to MSM, followed by heterosexual risk
(13%), MSM/IDU (2%), IDU (2%), and 23% have an unidentified exposure. Cases associated
with the No Identified Risk (NIR)/Other risk category could indicate two things: that these were
newer cases which have not yet had a full surveillance investigation, or that these were older
cases that are lost to follow-up with no risk established. However, CDC believes that
unidentified risk among women may be assigned because no sexual partners who were known to
be HIV-infected or high-risk for HIV could be identified. For males, it is also likely that some
percent of those individuals with unidentified risk do not report MSM contact due to stigma.
19
Table 2-1. Prevalence of HIV or AIDS, Demographic characteristics by Sex, Memphis
TGA, as of 2014
Total
Race/Ethnicity
White, not Hispanic
Black, not Hispanic
Hispanic
Other Not Hispanics
Current Age (as of 2014)
0 - 14 years
15 - 19 years
20 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55+ years
Exposure Category
Men who have sex with
men
Heterosexuals
Injection drug users
MSM&IDU
hemophilia/blood
transfusion
Perinatal Exposure
Risk not reported or
identified
Male (68%)
N
%
4,958
100%
Female (32%)
N
%
2,339
100%
Total
N
7,297
%
100%
756
3,919
128
155
15%
79%
3%
3%
199
2,034
43
63
9%
87%
2%
3%
955
5,953
171
218
13%
82%
2%
3%
13
47
285
1,047
1,148
1,442
976
1<%
<1%
6%
21%
23%
29%
20%
28
17
72
443
749
622
408
<1%
<1%
3%
19%
32%
27%
17%
41
64
357
1,490
1,897
2,064
1,384
<1%
<1%
5%
20%
26%
28%
19%
2,887
58%
2,887
40%
633
136
110
21
13%
3%
2%
<1%
1,601
102
68%
4%
7
<1%
2,234
238
110
28
31%
3%
2%
<1%
35
1,136
1%
23%
48
581
2%
25%
83
1,717
1%
24%
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, AR.
Persons living with HIV/AIDS in Shelby County, Tennessee
86% of all persons living with HIV or AIDS in the Memphis TGA reside within Shelby County
(Table 2-2). As such, demographic frequencies are similar to those previously discussed in the
TGA demographic section of persons living with HIV/AIDS. The majority of the PLWHA
population in Shelby County is male (68%). Among males, almost 80% are Non-Hispanic Black,
72% are above age 35, and 58% reported MSM contact as a risk exposure. Among females, 87%
are Non-Hispanic Black, 55% are between the child-bearing ages of 15-44 years, and 68%
reported heterosexual contact as a risk exposure. The percentage of undetermined risk exposure
among all males and females living in Shelby County is 23% at the end of 2014.
Map 2-2 displays the majority of persons living with diagnosed HIV infection are concentrated
in north west and south west part of Shelby county where Memphis city area limits; zip codes
within the North Memphis, Whitehaven, Westwood and the downtown areas report the highest
burden with rates of ( 885-1685 per 100,000 persons). The rates of persons living with diagnosed
20
HIV infection in these zip code areas are 3-5 times higher than that of MSAs total (293 per
100,000 persons) in the nation.
Map 2-2. Rates (per 100,000 persons) of PLWHA in Shelby County, Tennessee, as of 2014
Persons living with HIV/AIDS in Fayette and Tipton Counties, Tennessee
At the end of 2014, 162 individuals were reported to be currently living with HIV or AIDS in
Fayette and Tipton Counties in Tennessee, which comprises 2% of PLWHA in Memphis TGA
(Table 2-2). Approximately 67% of these individuals were male. Additionally, 28% of all
persons living with HIV or AIDS in Fayette and Tipton Counties in Tennessee were NonHispanic White and 65% were Non-Hispanic Black, which also differs from the Memphis TGA
PLWHA population (13% and 82%, respectively). Reported risk exposure is similar to the
overall TGA distribution: 35% reported MSM contact, 35% heterosexual contact and 22% had
undetermined risk. The number of persons living with HIV/AIDS in Fayette and Tipton were
spread across all age groups: 20-24 years (7%), 25-34 years (19%), 35-44 years (24%), 45-54
years (26%), and 55+ years (22%).
Persons living with HIV/AIDS in Northern Mississippi
Approximately 8% (n=594) of all persons living with HIV/AIDS in the Memphis TGA were
residing in the four Northern Mississippi counties at the end of 2014 (Table 2-2). The majority
reside within DeSoto County (n=398), followed by Marshall County (n=83), Tunica County
21
(n=76) and Tate County (n=36) (Map 2-1). The Zip code 38671 in DeSoto County has the
highest concentration of PLWHA (109 – 230 cases) in these four counties in Mississippi. (Map
2-2). Approximately 69% of the Northern Mississippi PLWHA population was male, and 31%
were female, which mirrors the overall TGA PLWHA population distribution (Table 2-2). The
majority are Non-Hispanic Black (65%) followed by Non-Hispanic White (30%), and 3% are
Hispanic. As similarly reported in the Memphis TGA, 45% attribute MSM contact as a risk
exposure, 4% attribute IDU, and 4% both MSM and IDU. A smaller percentage of heterosexual
contact is reported (19%) as compared to the Memphis TGA, but this is likely due to a larger
number of cases that have undetermined risk (28%). The number of persons living with
HIV/AIDS in Northern Mississippi is spread across all age groups: 20-24 years (6%), 25-34
years (20%), 35-44 years (25%), 45-54 years (30%), and 55+ years (19%).
Map 2-3. Persons Living with HIV/AIDS by Zip Code, Memphis TGA, 2014
Persons Living with HIV/AIDS in Crittenden County, Arkansas
At the end of 2014, 244 individuals were reported to be living with HIV or AIDS in Crittenden
County, Arkansas, which accounts for approximately 3.4% of the entire Memphis TGA PLWHA
population (Map 2-1). Crittenden County has the largest percentage of females living with HIV
disease in the Memphis TGA; 41% of all PLHWA were female and 59% were male (Table 2-2).
Approximately 80% were non-Hispanic Black and 14% are non-Hispanic White. The highest
percentage of heterosexual contact (34%) and IDU (11%) is reported in Crittenden County, while
MSM contact (30%) and undetermined risk (23%) are the lowest in the Memphis TGA. The
number of persons living with HIV/AIDS in Crittenden County is spread across all age groups:
22
20-24 years (4%), 25-34 years (12%), 35-44 years (31%), 45-54 years (24%), and 55+ years
(28%). Map 2-2 shows that the highest number of PLWHA are concentrated on the zip code area
72301, which is the border area of the West Memphis.
Table 2-2. Persons Living with HIV/AIDS by Geographic Residence and
Demographics/Risk Exposure Category, Memphis TGA, 2014
Total
Gender
Male
Female
Race/Ethnicity
White, not
Hispanic
Black, not
Hispanic
Hispanic
Other Race
Current Age
0 - 14 years
15 - 19 years
20 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55+ years
Exposure Category
MSM
Heterosexuals
Injection drug
users
MSM&IDU
blood transfusion
Perinatal
Exposure
Risk not
identified
North MS
Counties
594
8%
Crittenden,
AR
244 3%
Fayette and
Tipton, TN
162 2%
Shelby, TN
Memphis
TGA
6,297 86% 7,297 100%
412
182
69%
31%
144
100
59%
41%
108
54
67%
33%
4,294 68% 4,958
2,003 32% 2,339
176
30%
35
14%
45
28%
387
65%
196
80%
106
65%
15
16
3%
3%
*
*
*
*
*
*
*
*
149
185
2%
3%
171
218
2%
3%
*
*
35
118
147
179
110
*
*
6%
20%
25%
30%
19%
*
*
10
30
75
59
68
*
*
4%
12%
31%
24%
28%
*
*
11
31
39
42
35
*
*
7%
19%
24%
26%
22%
38
56
301
1,311
1,636
1,784
1,171
1%
1%
5%
21%
26%
28%
19%
41
64
357
1,490
1,897
2,064
1,384
1%
1%
5%
20%
26%
28%
19%
266
111
24
45%
19%
4%
72
84
26
30%
34%
11%
57
56
6
35%
35%
4%
2,492 40% 2,887
1,983 31% 2,234
182
3%
238
40%
31%
3%
22
*
*
4%
*
*
5
*
*
2%
*
*
4
*
*
2%
*
*
167
28%
55
23%
35
22%
699
11%
955
5,264 84% 5,953
79
24
77
1%
<1%
1%
110
28
83
1,460 23% 1,717
68%
32%
13%
82%
2%
<1%
1%
24%
*Case counts of less than five have been suppressed for statistical reliability and confidentiality guidelines.
Additional cells greater than five may be suppressed to prohibit back-calculation. This represents the number of
persons reported to be currently living with HIV or AIDS in the Memphis TGA as of December 31, 2014. Data is
considered provisional and subject to change.
23
AIDS Prevalence
As of 2014, almost 69% of people living with AIDS (stage 3 HIV infection) in the Memphis
TGA were male. The majority was Non-Hispanic Blacks (80%), followed by Non-Hispanic
Whites (13%) and 3% Hispanic/Latino (Table 2-3).
41% of all persons living with AIDS account their risk exposure to MSM contact, 31% to
heterosexual contact, and 20% have an unidentified risk transmission exposure. A higher
percentage of females living with AIDS are Non-Hispanic Black (86%) compared to NonHispanic Black males (77%). The vast majority of HIV-infected women have heterosexual risk
(70%), IDU (6%) and 21% have an unidentified risk exposure. Among males, 60% of the cases
are attributed to MSM, followed by heterosexual risk (14%), MSM/IDU (3%), IDU (3%), and
19% have an unidentified exposure.
Table 2-3. Prevalence of AIDS, Demographic characteristics by Sex,
Memphis TGA, as of 2014
Total
Race/Ethnicity
White, not Hispanic
Black, not Hispanic
Hispanic
Other Race
Current Age (as of 2014)
0 - 14 years
15 - 19 years
20 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55+ years
Risk/Exposure Category
Men who have sex with men
Heterosexuals
Injection drug users (IDU)
MSM&IDU
hemophilia/blood
transfusion
Perinatal
Risk not identified
Male (69%)
N
%
2471
100%
Female (31%)
N
%
1105
100%
Total
N
3576
%
100%
372
1914
68
117
15%
77%
3%
5%
76
953
24
52
7%
86%
2%
5%
448
2867
92
169
13%
80%
3%
5%
7
32
122
337
573
827
573
<1%
1%
5%
14%
23%
33%
23%
21
12
45
161
368
296
202
2%
1%
4%
15%
33%
27%
18%
28
44
167
498
941
1123
775
1%
1%
5%
14%
26%
31%
22%
1478
336
77
69
12
24
475
60%
14%
3%
3%
<1%
1%
19%
NA
772
66
NA
5
35
227
NA
70%
6%
NA
<1%
3%
21%
1478
1108
143
69
17
59
702
41%
31%
4%
2%
<1%
2%
20%
HIV Disease Incidence in the Memphis TGA
Incidence is a term commonly used in epidemiology to refer to newly diagnosed cases. Incidence
may be defined over a period of time that the new cases were diagnosed. For the purposes of this
24
report, incidence reflects cases diagnosed 2010 throughout 2014, and newly diagnosed AIDS
(Stage-3 HIV infection) cases include both previously diagnosed HIV cases that have progressed
to AIDS as well as newly identified AIDS cases that have not been previously identified as HIV
positive.
Map 2-4. HIV Disease Incidence in the Memphis TGA by County, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, AR
In 2014, there were 324 newly diagnosed HIV disease cases in the Memphis TGA. Among all
newly diagnosed HIV cases, 86.1% (n=279) were diagnosed among Shelby County residents,
while 5.6% were among DeSoto County residents, 4% among Crittenden County residents, 1.2%
and 1.5% among Fayette and Tipton County residents, and less than five cases have been
routinely reported in each of the remaining Mississippi Counties (Map 2-3).
Overall, the estimated numbers of new HIV infections have been decreasing from 429 in 2012 to
324 in 2014 in the Memphis TGA. The new HIV diagnosis (n=324) represents a 14% decrease in
2014 compared to the new HIV cases (n=376) in 2010 (Table 2-4). The number of new HIV
disease cases diagnosed among DeSoto, Crittenden, and Fayette county residents have remained
relatively stable over the past three years.
25
Table 2-4. Newly Diagnosed HIV Disease Cases by County, Memphis TGA, 2010-2014
Memphis TGA (Total)**
Shelby, TN
DeSoto, MS
Crittenden, AR
Fayette, TN
2010
376
327
18
12
7
2011
384
350
8
11
13
2012
429
386
17
10
7
2013
365
317
16
13
10
2014*
324
279
18
13
5
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, A. *Preliminary data subject to change
**Marshall, Tipton, Tate, Tunica counties routinely report less than five cases and are not listed but are included in
the overall Memphis TGA total. Case counts of less than five have been suppressed for statistical reliability and
confidentiality guidelines. Additional cells greater than five may be suppressed to prohibit back-calculation. Data is
considered provisional and subject to change.
Table 2-5 shows the characteristics of persons diagnosed with HIV between 2010 and 2014. The
majority were male, Non-Hispanic Blacks, age 15-34 years and MSM. Race/ethnicity
distributions were fairly similar year to year from 2010 to 2014, but data for recent years suggest
small increases in proportions of Non-Hispanic Whites. The proportion of new diagnoses among
persons aged 45-54 years decreased by 5%. However, the new HIV diagnosis among adolescents
and the young adults age 15-34 were increased from 53% in 2010 to 61% in 2013 and remained
stable in 2014. The majority of new cases were infected through male sex with male exposure.
Proportions of diagnoses among heterosexual contact, the second largest transmission category,
increased from 26% in 2010 to 36% in 2014. This is due to the improvement of documentation
of the risk exposure among the new HIV infections, which was decreased 40% in 2010 to 19% in
2014.
Table 2-5. Proportions of new HIV Cases by demographic characteristics,
Memphis TGA, 2010-2014
Total
Gender
Male
Female
Race/Ethnicity
White, not Hispanic
Black, not Hispanic
Hispanic
Other Race/ Not Specified
Age at Diagnosis (Years)
0 - 14 years
15 - 19 years
20 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
2010
376
Year of Initial HIV Diagnosis
2011
2012
2013
384
429
365
2014
324
74%
26%
70%
30%
71%
29%
76%
24%
72%
28%
9%
82%
4%
5%
9%
83%
3%
5%
13%
79%
3%
4%
10%
81%
3%
6%
12%
81%
3%
4%
<1%
6%
19%
28%
20%
18%
1%
8%
22%
21%
23%
20%
<1%
8%
22%
27%
16%
14%
<1%
6%
25%
30%
15%
16%
<1%
8%
23%
28%
18%
13%
26
55+ years
Exposure Category
Men who have sex with men (MSM)
Heterosexuals
Injection drug users (IDU)
MSM & IDU
hemophilia/blood transfusion
Perinatal Exposure
Risk not identified
8%
6%
13%
8%
10%
32%
26%
<1%
<1%
0%
<1%
40%
35%
29%
0%
<1%
0%
<1%
34%
31%
23%
0%
0%
0%
<1%
47%
51%
29%
<1%
<1%
0%
<1%
20%
44%
36%
0%
<1%
0%
<1%
19%
The overall rate in HIV disease incidence decreased between 2010 and 2014 (28.3 to 24.4 per
100,000 persons) in the Memphis TGA; In comparing five years of trend data, a 14% decrease of
HIV disease rate was observed between 2010 and 2014 (Table 2-6). This decrease occurred
among both males and females; however, males reported larger reductions in HIV disease
incidence than females. New HIV diagnoses rates among Hispanics/Latinos showed a large
decrease by 38% and among Non-Hispanic Blacks by 16%. During this same time period, new
HIV diagnosis among the Non-Hispanic Whites increased by 18%. Despite the decrease of new
infection among Hispanics, Table 2-6 shows that the rate of new infection (14.7) among the
Hispanics was more than two times of the new infection rate among the Non-Hispanic Whites.
The largest reductions in incidence were observed among persons aged 45-54 years (-40%) and
25-34 years (-22%). While an overall percent increase by 9% in incidence rates was observed in
youth and adolescents aged 15-24 years during 2010-2014. This trend shows that new HIV
infections shifted from the adult age group (25-54 years) to adolescents and young adults aged
15-24 years old in the Memphis TGA. The percentage of new cases identified as MSM and
heterosexual risk increased by 18% during the past year; however, this increase is likely due to
the proportion of undetermined risk decreasing by 60%.
Table 2-6. New HIV Disease Case Rates by Demographics, Memphis TGA, 2010-2014
2010
Total
Gender
Male
Female
Race/Ethnicity
White, not
Hispanic
Black,
not
Hispanic
Other Race
Age at Diagnosis
(Years)
0 - 14 years
2011
N
Rate
N
384
Rat
e
28.9
376
28.3
277
99
43.4
14.3
268
116
33
309
16
18
5.5
50.8
23.5
36.7
*
*
2012
N
429
Rat
e
32.3
42.0
16.8
304
125
33
320
10
21
5.5
52.6
14.7
42.8
*
*
2013
N
365
Rat
e
27.4
47.6
18.1
278
87
56
340
13
19
9.3
55.9
19.1
38.7
*
*
2014
N
2010 2014
324
Rat
e
24.4
%
Change
-14%
43.5
12.6
234
90
36.6
13.0
-16%
-9%
36
296
11
22
6.0
48.6
16.2
44.8
39
261
10
14
6.5
42.9
14.7
28.5
18%
-16%
-38%
-22%
*
*
*
*
0%
27
23 23.6 29 29.8 34 34.9 21 21.6 25 25.7
15 - 19 years
70 73.6 83 87.3 94 98.8 93 97.8 76 79.9
20 - 24 years
107 59.1 81 44.7 115 63.5 108 59.6 91 50.2
25 - 34 years
76 43.1 87 49.3 70 39.7 55 31.2 59 33.5
35 - 44 years
68 36.7 76 41.1 61 33.0 57 30.8 41 22.2
45 - 54 years
*
*
*
*
*
*
*
*
*
*
55+ years
Risk/Exposure
122
*
134
*
131
*
185
*
144
*
MSM
98
*
112
*
97
*
105
*
116
*
Heterosexuals
151
*
132
*
200
*
72
*
61
*
Risk not
identified
9%
9%
-15%
-22%
-40%
0%
18%
18%
-60%
Map 2-4. Rates (per 100,000 persons) of HIV/AIDS Prevalence and Incidence,
Shelby County, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN.
Rates of new HIV cases and rates of persons living with diagnosed HIV infection was shown by
zip code level in Shelby County in 2014 (Map 2-4). The darkest shaded area represents the
highest rates of PLWHA, and the largest blue circle shows the highest rates of HIV infection. In
the map, the darkest shaded area has largest blue circle. The positive correlation between the
28
rates of HIV/AIDS prevalence and the rates of HIV incidences clearly indicates that these zip
code area should be highly prioritized in terms of resource allocation for HIV testing, care and
treatments.
Figure 2-4. New HIV, AIDS, and Death Cases, Three Year Rolling Average,
West TN 3 Counties, 1984 - 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN.
As outlined in Map 2-3, among the eight counties in the Memphis TGA, the highest burden of
new HIV cases (89%) were on the three counties (Shelby, Fayette, and Tipton) in the Tennessee.
Thirty years of HIV data of these three counties in the west Tennessee are well documented in
Enhanced HIV/AIDS Reporting System (eHARS) and are readily available. Figure 2-4 shows
the three year rolling average of HIV, AIDS, and Death incidence in the three Tennessee
counties between 1984 and 2014. As shown in Figure 2-4, HIV disease epidemic in the
Tennessee counties can be described by three sequential phases.
The first phase is also called pre-HAART-era, which is before the advent of HAART (highly
active antiretroviral therapy) in 1996. During the first fifteen years of HIV/AIDS pandemic in the
pre-HAART era (1981-1996), new HIV cases sharply increased and reached its peak from 18
cases in 1984 to 529 case in 1994. Newly diagnosed AIDS cases and Death cases among the HIV
infected individuals also reached 2268 and 200 cases respectively in 1996.
The second phase of HIV disease epidemic started with introduction of the highly active
antiretroviral therapy (HAART) in 1996. The second phase lasted for ten years until the approval
of Ryan White Part A funding by Health Resources and Services Administration (HRSA). This
phase also called the post-HAART-era. During the second phase of HIV epidemic (1996 –
29
2007), despite the availability of antiretroviral drugs to limit the epidemic and prolong the lives
of those infected, the number of newly infected individuals continued to rise alarmingly. In the
three Tennessee counties, the incidence of HIV slightly decreased and remained fairly static at
approximately 450 new cases. Newly diagnosed AIDS cases showed a slight increase and
remained approximately 300 cases in 2007. Deaths remained a relatively static average 180 cases
each year.
The third phase of HIV epidemic, the Ryan White-era, began in 2007 onwards with the approval
of Part A funding for Shelby County, Tennessee from HRSA. During the Ryan White-era, the
HIV disease epidemic has been more limited and better controlled with the assistance of our
Ryan White HIV/AIDS program by providing primary medical care and essential support
services to those who do not have sufficient financial resources to cope with the disease in West
Tennessee. New HIV cases and deaths decreased approximately more than100 cases and 80
cases respectively between 2007 and 2014. However, newly identified AIDS cases decrease to
219 case in 2009 and gradually increase to 268 cases in 2013. This increase is partly due to
increasing awareness of the persons living with HV who did not know their HIV status. These
achievements of limiting and controlling the HIV epidemic in the West Tennessee notably
underscore the success of the Memphis TGA Ryan White part A HIV/AIDS program.
AIDS Incidence in the Memphis TGA
While HIV disease surveillance data represents trends in HIV transmission, AIDS surveillance
data reflects differences in access to testing and treatment. According to the CDC 2013 HIV
Surveillance report, the Memphis MSA new AIDS diagnoses rate was ranked number one among
all MSAs in 2013 (Figure 2-2). In the Memphis TGA, new AIDS cases gradually decreased
from 322 cases in 2010 to 248 cases in 2012. However, new AIDS cases increased 35% in 2013.
The three Tennessee counties (Shelby, Fayette, and Tipton Counties) account for 95% of new
AIDS diagnosis among all Memphis TGA counties (Table 2-7). Preliminary data reflects a
decrease in 2014 among newly diagnosed AIDS cases; however, this number is provisional and
will likely increase.
Table 2-7. New AIDS diagnoses by region in Memphis TGA, 2010 - 2014
2010
2011
2012
2013
N
%
335
319 95%
16
5%
2014*
N
%
214
190 89%
24
11%
N
%
N
%
N
%
Memphis TGA
322
281
248
299 93% 256 91% 228 92%
West
Total TN 3
23
7%
25
9%
20
8%
North
MS 4
Counties
Counties
&
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, AR. *preliminary data, subject to change
Crittenden
County
In 2014, AIDS incidence rates among males (22.9 per 100,000) are over twice female rates (9.8
per 100,000) in the Memphis TGA. Blacks represent the majority of new AIDS cases; the AIDS
incidence rate among Non-Hispanic Black individuals (26.9 per 100,000) was nine times that of
Non-Hispanic Whites (3.0 per 100,000). Persons aged 25-34 and 35-44 years reported the
highest number of newly diagnosed AIDS case. The incidence rates 55.2 and 51.0 per 100,000
persons in 2010 decreased to 28.2 and 21.6 respectively per 100,000 persons in 2014. However,
new AIDS diagnosis rates among the adolescents aged 15-19 years old increased over four times
from 18.5 per 100,000 persons in 2010 to 80.1 per 100,000 persons in 2013 (Table 2-8).
30
Table 2-8. Rates of Newly Diagnosed AIDS cases (per 100,000 persons) by Demographic
Characteristics, Memphis TGA, 2010 - 2014
Total
Gender
Male
Female
Race/Ethnicity
White, not
Hispanic
Black,
not
Hispanic
Other Race, Not
Specified
Age
at Diagnosis
0 - 14 years
15 - 19 years
20 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55+ years
Other
2010
N
Rate
322 24.2
2011
N
Rate
281 21.1
2012
N
Rate
248 18.6
2013
N
Rate
335 25.2
2014*
N
Rate
214 16.1
220
102
34.4
14.8
190
91
29.7
13.2
154
94
24.1
13.6
225
110
35.2
15.9
146
68
22.9
9.8
33
272
12
5
5.5
44.7
17.6
10.2
22
240
11
8
3.6
39.4
16.2
16.3
30
208
4
6
5.0
34.2
5.9
12.2
24
225
12
74
18
164
5
27
3.0
26.9
7.4
55.0
0
18
45
100
90
45
24
48
0.0
18.5
47.3
55.2
51.0
24.3
7.8
…
0
27
31
66
77
55
25
50
0.0
27.7
32.6
36.4
43.7
29.7
8.1
…
2
11
44
71
70
33
17
39
0.7
11.3
46.3
39.2
39.7
17.8
5.5
…
25
78
73
58
52
31
18
33
4.0
37.0
17.6
150.
8
8.8
80.1
76.8
32.0
29.5
16.8
5.8
…
14
36
40
51
38
19
16
17
4.9
37.0
42.1
28.2
21.6
10.3
5.2
…
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; MS, AR. *preliminary data, subject to change.
Late HIV Diagnosis
Late HIV diagnosis is one of the system level indicators for Department of Health and Human
Services (HHS) – funded HIV programs and services of the HIV/AIDS Bureau. Late HIV
diagnosis defined as: Number of persons with a diagnosis of Stage 3 HIV infection (AIDS)
within 3 months of diagnosis of HIV infection in the 12-month measurement period. The West
Tennessee three counties (Shelby, Fayette, and Tipton) in the Memphis TGA accounted for 95 %
of new AIDS diagnoses in 2013 (Table 2-7). Due to the limitation of Late HIV diagnosis data
availability from the north Mississippi four counties and Crittenden County in Arkansas, Late
HIV diagnosis in the Memphis TGA can be described by using the west Tennessee three
counties data.
The Proportion of Late HIV Diagnosis increased from 17% in 2010 to 28% in 2013. Among the
332 newly diagnosed HIV cases in 2013, 92 of them were diagnosed as stage 3 HIV infection
(AIDS) within the three months of HIV diagnosis in 2013 (Table 2-9). The majority of the Late
HIV Diagnosed cases were males (73%), Non- Hispanic Blacks (72%), and adolescents and
young adults aged 15-34 years old (56%) (Figure 2-5). While reductions in HIV disease
incidence may be testament to successful prevention measures, the increasing AIDS incidence
rate indicates that new cases are not being identified as early as possible.
31
Table 2-9. Late HIV Diagnoses in the West Tennessee three Counties, 2010 – 2014
Total New HIV Diagnoses
Late HIV Diagnoses (N)
Late HIV Diagnoses (%)
2009
402
68
17%
Year of Initial AIDS Diagnoses
2010
2011
2012
2013
341
367
396
332
73
73
73
92
21%
20%
18%
28%
2014*
288
72
25%
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; *preliminary data, subject to change.
Figure 2-. Demographic Characteristics of Late HIV Cases in the
three Tennessee Counties, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; *preliminary data, subject to change.
HIV Mortality
The mortality data in persons with HIV infection (Table 2-10) shows average 126 deaths cases
occurred in the Memphis TGA between 2010 and 2013. During this period of time the proportion
of deaths among the HIV infected persons was stable by gender, racial/ethnic groups, and risk
exposure category. Majority of deaths occurred among the males and not Hispanic Blacks. In
comparing the four year data between 2010 and 2013, the proportion of deaths among the
younger age group decreased, the higher proportion of deaths occurred among the older age
group. The older age group 55+ years old accounted for 27% deaths in 2010, the same age group
accounted for 40% of deaths in 2013. Although the number of death among the PLWHA did not
significantly changed between 2010 and 2013, the proportion of death shifted from younger age
group to older age group. This success of increasing life span of PLWHA may be due to the
improvement of HIV care measures. It is important to note that Table 2-10 does not reflect all
death caused by HIV disease.
32
Table 2-10. Deaths in Persons with HIV infection, by Demographics and Risk
characteristics, Memphis TGA, 2010 - 2013
2010
Total
Gender
Male
Female
Race/Ethnicity
White, not Hispanic
Black, not Hispanic
Hispanic
Other Races
Age at Death
0 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55+ years
Exposure Category
Men who have sex with
men (MSM)
Heterosexuals
Other Risk
Risk not identified
2011
2012
2013
N
143
%
N
110
%
N
115
%
N
139
%
93
50
65%
35%
72
38
65%
35%
77
38
67%
33%
99
40
71%
29%
14
121
3
5
10%
85%
2%
3%
10
96
2
2
9%
87%
2%
2%
8
104
0
3
7%
90%
0%
3%
18
119
0
2
13%
86%
0%
1%
4
15
41
44
39
3%
10%
29%
31%
27%
1
17
23
35
34
1%
15%
21%
32%
31%
1
14
31
36
33
1%
12%
27%
31%
29%
1
11
36
36
55
1%
8%
26%
26%
40%
49
34%
27
25%
28
24%
46
33%
58
9
27
41%
6%
19%
46
8
29
42%
7%
26%
39
11
31
34%
10%
27%
40
13
40
29%
9%
29%
3. HIV-Related Co-Morbidities and Social Factors
Sexually Transmitted Infections
Sexually transmitted infections (STIs) are known to increase the risk of both transmitting and
acquiring HIV. According to the Centers for Disease Control and Prevention, the Memphis
Metropolitan Statistical Area (MSA) ranked first in the country among the 50 largest MSAs in
2013 for Chlamydia and Gonorrhea infection7; the impacts of these extraordinarily high rates of
STIs increase the risk of HIV infection within the Memphis TGA.
Table 3-1: STD Incidence Rates (per 100,000 persons) in Memphis MSA
and U.S. MSA total, 2009 – 2013
Chlamydia
Gonorrhea
Memphis, TN-MSAR
U.S. MSA TOTAL
Memphis, TN-MSAR
U.S. MSA TOTAL
2009
1021
2010
942.5
2011
878.3
2012
949.8
2013
802.2
430.1
345.9
450.9
309
479.2
288.7
474.2
335.2
462.7
230
108.6
113.7
116.4
120
118.1
33
Primary and
Secondary
Syphilis
Late and Late
Latent Syphilis
Memphis, TN-MSAR
U.S. MSA TOTAL
Memphis, TN-MSAR
U.S. MSA TOTAL
14.4
12.5
9
8.2
7.8
6.1
59.2
6.3
57.4
6.3
44.0
7.1
44.0
7.8
43.1
19.8
20.6
20.8
22.8
25.5
Data Source: Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2013.
Atlanta: U.S. Department of Health and Human Services; http://www.cdc.gov/std/stats13/surv2013-print.pdf
Chlamydia
According to the 2010 CDC Sexually Transmitted Disease Treatment Guidelines, sexually active
PLWHA should be screened annually for Chlamydia, as infection is often asymptomatic and
unlikely to be recognized unless testing occurs8. Chlamydia incidence rates in the Memphis TGA
reached a peak in 2009 and the rate steadily decreased from 1,021 to 802.2 (per 100,000 persons)
in 2013. However, the incidence rate of chlamydia still remained over twice the incidence rate of
national MSAs during 2009-2013. Chlamydia incidence rate in Shelby county residents was
higher than that of Memphis MSAs, and two times higher than MSAs total average rate and three
times higher than that of Tennessee in 2013 (Table 3-2).
Table 3-2. Chlamydia Incidence Rates (per 100,000 persons) of reported cases in Memphis,
TN-MS-AR and U.S. MSA, 2009 - 2013
Region
Shelby County
Memphis, TN-MS-AR
MSAs Total
Tennessee
2009
1,168.1
1,021.0
430.1
262.4
2010
1,074.8
942.5
450.9
250.5
2011
1,047.7
878.3
479.2
285.3
2012
1,055.1
949.8
474.2
309.8
2013
905.1
802.2
462.7
295.7
Data Source: http://www.cdc.gov/std/stats13/surv2013-print.pdf
There were 136 co-morbid cases of HIV/Chlamydia reported in Shelby County during 2014,
with 8,122 total cases of chlamydia reported in the general population (Table 3-4). In 2014, the
Chlamydia rate among PLWHA (2,160 per 100,000 persons) was almost 2.5 times the rate
reported in the general population (864.6 per 100,000 persons). The main burden of Chlamydia
and Gonorrhea infections are on adolescents and young adults in the Memphis TGA. Chlamydia
rates (4,091 per 100,000 persons) among Shelby County adolescents age 15-19 years old are
approximately 2 times rates of those in Tennessee and U.S. totals in 2014 (Table 3-3).
Table 3-3. Chlamydia and Gonorrhea Rates among Adolescents ages 15-19 Years, Shelby
County and Tennessee, and National, 2014
Chlamydia
Gonorrhea
Shelby Co.
4,091.0
970.0
Tennessee
2,108.6
373.4
U.S. Total
1,852.1
337.5
Data Source: PRISM, TN. http://www.cdc.gov/std/stats13/surv2013-print.pdf
34
Gonorrhea
In addition to annual Chlamydia screening, CDC guidelines also recommend annual screening
for Gonorrhea among sexually active PLWHA8. Gonorrhea rates in the Memphis MSA have
declined since 2009, but remained two times the National MSA rate in 2013 (Table 3-1). The
Gonorrhea rate identified in 2014 among the PLWHA population (1,636 per 100,000 persons) is
over three times the rate reported among the total TGA population (231.2 per 100,000 persons)
for Shelby County (Table 3-4). Gonorrhea rates (970 per 100,000 persons) among Shelby
County adolescents age 15-19 years old are approximately 3 times those of Tennessee
adolescents of the same age (Table 3-3).
The Memphis TGA has the highest reported sexually transmitted infection rates in the U.S. For
all the nationally notifiable STIs, Chlamydia and Gonorrhea rates in the Memphis TGA are
double or more than double the average national rate among the general population7. Although
the largest fractions of those cases are diagnosed in 15-24 year old patients, rates remain high in
all population groups in the Memphis TGA when compared with national rates.
Syphilis
Syphilis remains a significant problem in the South and in urban areas of the United States.
Increases in cases among MSM have occurred and have been characterized by high rates of HIV
co-infection and high-risk sexual behaviors nationally9. Table 3-1 shows that while U.S. MSAs
total early and late latent syphilis rates were increasing, Memphis MSA Syphilis rates were
decreasing trend between 2009 and 2013. Following a peak of 14.4 per 100,000 persons in 2009,
rates of Primary and Secondary (P&S) Syphilis declined by 46% to 7.8 per 100,000 persons in
2013. Late Latent Syphilis rates decreased by 27% during this time period, but remained more
than 1.5 times higher than that of national rates. This trend of decreasing rate of all Syphilis
incidences indicates the improvement of prevention and treatment measures in the Memphis
TGA.
In 2014, there were 29 co-morbid cases of HIV/P&S Syphilis reported in Shelby County, with
182 total cases in the general population (Table 3-4). The rate among PLWHA (1827.7 per
100,000) was 24 times the rate reported in the general population (56.6 per 100,000). P&S
syphilis may be easily treatable with antibiotics; however, treatment for HIV/syphilis coinfection may be more difficult and costly. Patients with HIV may have atypical antibody
response to treatment, resulting in the need for repeated testing and follow-up.
Table 3-4. STD Co-Morbidities Reported among Persons Living with HIV Disease and the
General Population, Shelby County TN, 2014
Tuberculosis
(TB) Syphilis
P&S
Gonorrhea
Chlamydia
Among the General population
N
Rates (per 100,000
52
5.6
persons)
182
19.4
2172
231.2
8122
864.6
N
11
29
103
136
Among the PLWHA
Rates (per 100,000
174.8
persons)
460.7
1636
2160.2
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; NEDSS, TN; PRISM, TN.
35
As outlined in Table 3-4, the high level of co-infection rate of STDs among the PLWHA shows
that there is ongoing sexual risk-taking among the HIV infected MSM in Shelby County. The
higher concentration of HIV/P&S Syphilis co-infection occurred in the higher HIV incidence and
prevalence zip code areas (38103 - 38105, 38107, 38126, 38115) in downtown and south
Memphis, and the lower level of concentration of HIV/STD co-infection occurred further from
the highly concentrated HIV incidence and prevalence zip code areas (Map 3-1). This finding is
of special concern because STDs facilitate HIV transmission.
Among the PLWHA in Memphis TGA, STI infection rates are double or more than double the
rates of those infections in the HIV-negative population. The evidence is overwhelming that STI
and HIV co-infection has a tremendous adverse impact on our PLWHA clients and also
demonstrates the need for a combination of increased transmission risk-reduction education and
viral load suppression for PLWHA clients and citizens living in the TGA. Together these
strategies can help slow the transmission of HIV in the community. These strategies are
important for all PLWHA in the Memphis TGA, but young black MSM should particularly
continue to receive outreach intended to mitigate transmission risk because that sub-population
seems to be the current focus of HIV transmission based on the available epidemiologic data.
Map 3-1. Rates (per 100,000) of HIV/AIDS Prevalence, Incidence, and
Co-Infected P&S Syphilis, Shelby County, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; NEDSS, TN; PRISM, TN.
36
Tuberculosis (TB)
Among persons infected with latent tuberculosis (TB) infection, HIV is the strongest risk factor
for progressing to active TB disease. Over a lifetime, only 10 percent of people with latent TB
infection who have normal immune systems will progress to develop active disease10. Untreated
latent TB infection can quickly progress to TB disease in people living with HIV since the
immune system is already weakened. And without treatment, TB disease can progress from
sickness to death9. TB is also one of the AIDS-Defining Conditions. Thus, TB screening for
PLWHA is particularly important. According to CDC, direct costs (in 2010 U.S. dollars) average
from $17,000 to treat drug-susceptible TB to $430,000 to treat the most drug-resistant form of
the disease (XDR TB).
Table 3-5. Tuberculosis Cases and Rates in MSAs and Shelby County in 2013
Shelby County
Memphis, TN-MS-AR
MSAs Total
Tennessee
Number of Cases
48
55
7,657
142
Rate (per 100,000 persons)
5.6
4.1
3.6
2.2
Data Source: The National Electronic Disease Surveillance System (NEDSS);
In 2013, 55 new TB cases were diagnosed in the Memphis Metropolitan Statistical Area (MSA).
In the Memphis MSA, TB incidence rate was higher than that of total MSAs in the Nation; and
almost two times higher than the rate of Tennessee in 2013. TB incidence rate in Shelby County
was almost two times higher than that of total MSAs in the Nation (Table 3-5). In 2014, newly
reported tuberculosis case rate (174.8 per 100,000 persons) among the PLWHA was more than
thirty one times the rate (5.6 per 100,000 persons) reported in the general population in Shelby
County (Table 3-4).
4. Indicators of HIV Risk among Disproportionately Impacted Populations
The epidemic continues to disproportionately impact several populations within the Memphis
TGA, including Non-Hispanic Black males who have sex with males (MSM), youth and young
adults between the ages of 15-34, Non-Hispanic Black women of child-bearing age, Hispanics,
those formerly incarcerated PLWHA and the homeless.
Black/African American MSMs
HIV testing data shows that the highest number of tests (n=11,657, 82%) were conducted for the
Non-Hispanic Blacks in Shelby county health department in 2014. Among the other race/ethnic
groups, Non-Hispanic Blacks show highest test positivity (Table 4-6). Male-to-male sexual
contact was the most commonly reported risk exposure category (44%) among the new HIV
cases in the Memphis TGA (Table 2, 5-6). Although the numbers of newly diagnosed HIV cases
have decreased 16% from 309 cases to 261 cases among the Non-Hispanic Blacks between 2010
and 2014, the proportion of new HIV cases of the Non-Hispanic Blacks among the other
race/ethnicity did not show significant decrease. As outlined in Table 5-1 Non- Hispanic Blacks
accounted for 81% of all newly diagnosed HIV disease cases in the West Tennessee three
37
counties in 2014. Male-to-male sexual contact represents the largest portion of cases (59%)
among the Non-Hispanic Black males. In addition, 77% of newly diagnosed AIDS cases were
among the Non-Hispanic Blacks in the Memphis TGA, in 2014 (Table 2-8).
Table 5-1. Newly diagnosed HIV Cases among the Black Males in the West Tennessee three
counties, 2014*
Total
Sex
Male
Female
Race/Ethnicity
White, Not Hispanic
Black, Not Hispanic
Hispanic, All Races
Other, Not Hispanic
Age at Diagnosis
0 to 14
15 to 19
20 to 24
25 to 34
35 to 44
45 to 54
55+
Risk/Exposure
Male Sex with Male
Heterosexual Contact
Other Risk Exposure
Risk not Identified
In West TN
N
%
288
Males
N
208
%
Blacks
N
%
233
Black Males
N
%
169
169
64
73%
27%
169
208
80
72%
28%
208
34
233
9
12
12%
81%
3%
4%
23
169
8
8
11%
81%
4%
4%
2
24
63
80
53
37
29
<1%
8%
22%
28%
18%
13%
10%
…
21
52
65
34
20
16
…
10%
25%
31%
16%
10%
7%
1
14
57
64
44
30
23
<1%
6%
24%
27%
19%
13%
10%
…
14
48
54
27
14
12
…
8%
28%
32%
16%
8%
7%
129
111
3
45
45%
39%
1%
16%
129
40
1
38
62%
19%
<1%
18%
100
91
2
40
43%
39%
<1%
17%
100
33
1
35
59%
20%
<1%
21%
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; *: preliminary data subject to change
A large percentage of newly diagnosed cases (21%) have unidentified risk/exposure, which
causes limitations in fully understanding the incidence of infection among males attributed to
MSM or heterosexual contact in 2014. The high percentage of cases for which no transmission
category was identified may be due in part to under-reporting of male-to-male sexual activity
because of stigma. In addition, unidentified risk exposure may be assigned among heterosexuals
if no HIV-infected or high-risk partners could be identified. The disproportionally impact of
HIV/AID on Non-Hispanic Blacks is shown in Figure 5-1. Non-Hispanic Blacks comprised 46%
of the Memphis TGA population, they accounted for 81% of newly diagnosed HIV cases, while
12% of newly diagnosed cases were attributed Non-Hispanic White counterparts.
38
Figure 5-1 Proportions of Population and Newly Diagnosed HIV Cases,
Memphis TGA, 2014
Data Source: U.S. Census Bureau, 2011-2013 3-Year American Community Survey; Enhanced HIV/AIDS Reporting
System (eHARS), TN; MS, AR.
Unmet need analyses and mortality rates furthermore suggest Non-Hispanic Black men are at an
increased risk for poor health outcomes. The 2014 unmet need analysis reported that 70% of
individuals out of care were males, and approximately 85% were Non-Hispanic Blacks (Table 43). The 2012 Ryan White Comprehensive Needs Assessment found that stigma among males
may contribute to challenges to serving this population. Males were significantly more likely
than females to report perceived HIV-related stigma; nearly 60% of those who sometimes/often
thought their HIV diagnosis was punishment for things done in the past were men. Historically in
the Black community there has been denial of MSM activity, significant stigma and profound
lack of acceptance of MSM behavior. Many Black MSM do not identify as homosexual making
it particularly difficult to reach and serve this population. Others are socially and economically
marginalized due to race, poverty, criminal history, mental illness, substance abuse and other
factors. These issues create an additional layer of barriers to engage them in care. Also, it is
believed that many Black MSM engage in heterosexual activity as well, thus fueling
transmission of HIV to women. Given these factors, there is likely a significant service gap for
Black MSM.
Adolescents and Young Adults aged 15-34
The entire spectrum of HIV disease epidemic is shifting to adolescents and young adults in the
Memphis TGA. Adolescents and young adults aged 15-34 years old accounted for 59% of new
HIV cases in 2014 (Table 2-5). This disproportionate impact of new HIV infection was more
notably expressed among the black males in the same age group (68%) in West TN counties
39
(Table 5-1). As outlined in the 2014 AIDS incidence data (Table 2-4), the age group 15-24 years
old accounts for 59% (n=127) new AIDS diagnosis in the Memphis TGA. Looking more closely
to the West Tennessee threes counties, 58% of newly HIV cases, 61% of newly AIDS cases, and
56 % of late HIV cases were diagnosed among the age group 15 – 34 years old (Figure 5-2).
Figure 5-2 New HIV, New AIDS, and Late HIV Diagnosis by age group, West TN, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN;
Unmet Need data demonstrates that higher proportions (52%) of the persons not receiving
medical care were in the age-group 25-44 years old (Table 4-3) in the West Tennessee Counties,
in 2014. The HIV testing data shows the highest HIV testing positivity (5.4%) among the
adolescents and youth aged 15-34 years old in the West Tennessee counties in 2014 (Table 4-6).
According to the CDC HIV Surveillance report 2013, newly diagnosed HIV rates among the age
group 15-19 years old and 20-24 years were more than two times and almost three times higher
respectively in the Memphis TGA compare to that of among the same age group in the United
States in 2013 (Figure 5-3).
Figure 5-3. Rates of Newly Diagnosed HIV Case (per 100,000 persons) by age group in
United States and Memphis TGA, 2013
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; CDC (2013) HIV Surveillance Report, 2013.
40
The Youth Risk Behavioral Surveillance (YRBS) conducted in 2013 reported that approximately
59.7% of respondents had ever had sex, 38.2% were currently sexually active, 22.8% had four or
more sexual partners, and almost 32.5% did not use a condom at last sexual intercourse; 25% of
respondents to the Memphis YRBS survey reported they had never been taught about HIV/AIDS
in school, which is almost two times higher than the national figure of 14.7% (Table 5-2).
Table 5-2. Sexual Health Responses from the Youth Risk Behavior Survey among 9-12th
Graders in Memphis and the Nation, 2013
Ever had sex
Currently sexually active
4+ sexual partners
Did not use a condom at last sexual intercourse
Never taught about HIV/AIDS in school
Memphis, TN
59.70%
38.20%
22.80%
32.50%
25.30%
Nation
46.80%
34%
15%
41%
14.70%
Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey 2013
In the 2012 Memphis TGA Ryan White Comprehensive Needs Assessment, young adults were
significantly more likely to report engaging in risky sexual behaviors; among those 18-24 years,
29% reported having sex while drunk or high and 42% also reported having a prior STD
diagnosis. Table 3-4 outlines that Chlamydia and Gonorrhea rates among the adolescents and
young adults aged 15-19 years old in Shelby County almost three times higher than that of in the
United State.
Youth and young adults face unique challenges in accessing care and other needed services. In a
2010 Needs Assessment report developed by the Tennessee Ryan White Part B Planning Group,
youth identified several barriers to HIV care including incarceration, substance abuse, fear, and
anxiety associated with HIV-related stigma. Eighty-one percent of the twenty-seven youth
interviewed at St. Jude Children’s Research Hospital felt depressed, worthless or hopeless in past
year. Unstable housing also contributed to 22% of youth having no place to stay at least once in
the past year. Another 26% reported experiences with domestic violence. While many youth
stated challenges in accessing care, some respondents that had interruption in treatment in the
past five years noted favorable factors that facilitated their return back into care. These factors
included outreach workers assisting with care, follow-ups from medical case managers, and
direct help after jail/prison release. The reports shows the need to develop new, collaborative,
cross-institutional, coordinated care strategies capable of addressing the structural complexity of
adherence barriers and unmet care and supportive service needs of HIV-infected youth. The
report also suggested developing collaborative efforts to address the adherence barriers
associated with incarceration, frequent substance use, unstable housing, access to food pantry
and the need for support groups and psychosocial services that address the problem of HIVrelated stigma.
Black/African American Women of Child-Bearing Age
In Memphis TGA, 87% of women living with HIV/AIDS are Non-Hispanic Black, and 55% are
between the child-bearing ages of 15-44 years according to 2014 data (Table 2-3). In the West
41
Tennessee three counties, among the newly diagnosed female HIV cases, Non-Hispanic Black
females account for 80% of new HIV cases, and 91% were infected through heterosexual contact
in 2014 (Table 5-3). While the incidence of HIV disease has decreased significantly among
women over the past five years, this population is of particular interest not only due to the health
and well-being of women within the Memphis TGA, but also in the prevention of perinatal
transmission.
Table 5-3. Newly diagnosed HIV Cases among the Black Females in
the three Tennessee counties, 2014*
Total
Sex
Male
Female
Race/Ethnicity
White, Not Hispanic
Black, Not Hispanic
Hispanic, All Races
Other, Not Hispanic
Age at Diagnosis
0 to 14
15 to 19
20 to 24
25 to 34
35 to 44
45 to 54
55+
Risk/Exposure
Male Sex with Male
Heterosexual Contact
Other Risk Exposure
No Identified
In West TN
N
288
Females
80
Blacks
100%
233
169
64
Black Females
64
100%
73%
27%
64
100%
208
80
72%
28%
80
100%
34
233
9
12
12%
81%
3%
4%
11
64
1
4
14%
80%
1%
5%
2
24
63
80
53
37
29
<1%
8%
22%
28%
18%
13%
10%
…
2
3
11
15
19
13
…
3%
4%
14%
19%
24%
16%
1
14
57
64
44
30
23
<1%
6%
24%
27%
19%
13%
10%
1
…
9
10
17
16
11
<1%
…
14%
16%
27%
25%
17%
129
111
3
45
45%
39%
1%
16%
71
2
7
89%
2%
9%
100
91
2
40
43%
39%
<1%
17%
58
1
5
91%
2%
8%
Perinatal transmission of HIV
HIV transmission from mother to child during pregnancy, labor and delivery, or breastfeeding is
known as perinatal transmission and is the most common route of HIV infection in children.
When HIV is diagnosed before or during pregnancy, perinatal transmission can be reduced to
less than 1% if appropriate medical treatment is given, the virus becomes undetectable, and
breastfeeding is avoided. According to the TN eHARS data, 199 babies were born to HIV
infected mothers in the West Tennessee three counties in five years between 2008 and 2012;
83% (n=166) babies were diagnosed as pediatric seroreverters, 11% babies were in pediatric HIV
exposure status, and 3% of them were diagnosed as pediatric AIDS (Figure 5-4). Of these, 91%
(n=181) babies were born from the HIV infected Non-Hispanic Black mothers (Table 5-5).
42
During these five years, although the number of babies born to HIV infected mothers increased
from 22 cases in 2008 to 50 cases in 2012, the proportion of pediatric seroreverters increased
from 59% to 92%, and the proportion of pediatric AIDS cases decreased from 9% to 2%
(Figure 5-6).
Figure 5-4. Babies born with HIV infected mothers by Race/Ethnicity,
three Tennessee counties, 2010 – 2014
Figure 5-5. Race and Ethnicity of babies born with HIV infected mothers by
Race/Ethnicity, three Tennessee counties, 2010 – 2014
43
Figure 5-6. Trends of Perinatal HIV infection, West Tennessee Counties, 2008 – 2012
According to the STD surveillance conducted by CDC in 2013, rates of congenital syphilis in
Tennessee have continually decreased from 15.8 in 2009 to 2.5 in 2013. Between 2009 and 2014,
36 congenital syphilis cases were diagnosed among Shelby County infants; 83% of these births
occurred among infants born to Black mothers (Figure 5-7).
Figure 5-7. Cumulative congenital syphilis cases by Race/Ethnicity, the three Tennessee
Counties, 2010 – 2014
Data Source: PRISM, TN
The Unmet Need data (Table 4-3) shows Non-Hispanic Black women of child-bearing age
account for 56% of clients with all unmet need females, and the main modes of HIV
transmission (64%) was Heterosexual for those not receiving medical care during 2014 in the
44
West Tennessee three counties. Factors that impede access of Black women to the HIV service
delivery system include poverty, lack of health insurance, social stigma associated with HIV,
lack of transportation, childcare burdens, and other psychosocial factors that may affect an
individual’s ability to access or remain in care. Engaging women in care when they are
struggling to meet the basic necessities of life, while raising children, is a significant challenge.
Hispanics
In 2014, Hispanics accounted for 2% (n=171) of all PLWHA in the Memphis TGA (Table 2-2).
While this is a relatively small number, the rate of newly diagnosed HIV cases among Hispanics
in the West Tennessee Counties remained fairly stable from 2010 thru 2014, and was more than
two times higher than that of Non-Hispanic Whites in 2014 (Figure 5-8). Additionally, HIV
testing data from publicly funded test sites reports that Hispanics are underrepresented among
those receiving testing. Of the 14,028 tests conducted at the Shelby County Health Department
during 2014, 284 (2%) were administered among the Hispanic population, although Hispanics
represent approximately 5% of the Memphis TGA population.
Figure 5-8. Rates of Newly diagnosed HIV by Race/Ethnicity,
in the Memphis TGA, 2010 – 2014
Hepatitis Infection
The CDC reports that one-quarter of HIV-infected persons are also infected with Hepatitis C
(HCV) and an estimated 50% to 90% of persons infected with HIV through injection drug use
(IDU) are also infected with HCV. HCV co-infection increases the risk of severe side effects
from HIV medications, and co-infection can accelerate the rate at which HCV-related liver
disease progression and non–AIDS cause of death in HIV infected individuals10.
In Tennessee, positive labs indicative of Hepatitis A, B, and C are reportable to the health
department for further classification into acute or chronic disease. There were 62 acute Hepatitis
A, B, and E cases, but no acute Hepatitis C cases reported in the West Tennessee three counties
45
in 2014 (NEDSS). HIV/Hepatitis co-morbidity does not seem to be a major problem for newly
diagnosed HIV disease clients in the Memphis TGA recently, but it remains an important risk
factor for previously diagnosed patients and may re-emerge as a significant transmission risk
factor in the future.
The Memphis TGA prevalence data indicates that 5% (n=348) PLWHA report injection drug use
(IDU) or men who have sex with men and inject drugs (MSM/IDU) as a risk exposure category
(Table 2-2); however, there is only one newly diagnosed HIV disease case in 2014 attributed to
MSM/IDU.
Homelessness
Stable housing is essential for successful treatment of HIV/AIDS12. A research finding by the
Centers for Disease Control and Prevention (CDC) shows that housing status is a stronger
predictor of HIV health outcomes than individual characteristics such as gender, race, age, drug
and alcohol use, mental health issues and receipt of social services13. The high prevalence of
homelessness and persons experiencing unstable housing conditions significantly increases the
cost and complexity of HIV care. This study have also reported that homeless and unstably
housed PLWHA who improved their housing status reduced risk –behaviors by half, while those
whose housing status worsened were four times as likely to increase risks through activities such
as sex exchange14.
In January 2014, The National Alliance to End Homelessness reported that from 2012 to 2014,
overall homelessness in Memphis-Shelby County decreased by 21 percent and chronic
homelessness among individuals decreased by 39 percent15. The National Alliance to End
Homelessness also estimates that every year approximately 3.4% of homeless individuals are
infected with HIV disease in U.S; However, in Memphis TGA, 5% (194) Ryan White clients
were documented to be non-permanently housed in 2014 (CAREWare, TN).
5. HIV Care Continuum for FY 2015
The goals of the National HIV/AIDS Strategy are reducing new HIV infections, improving
health outcomes among persons living with HIV, and reducing HIV-related disparities. President
issued an executive order in July 2013 establishing the HIV Care Continuum Initiative16 to help
people who are infected with HIV get diagnosed, linked to care, and treated for HIV.
The HIV care continuum is a model that outlines the sequential steps or stages of HIV medical
care that people living with HIV go through from initial diagnosis to achieving the goal of viral
suppression, and shows the proportion of individuals living with HIV who are engaged at each
stage. The stages of HIV Care Continuum include Diagnosed, Linked to Care, Retained in Care,
Prescribed ART, and Virally Suppressed.
The recent study in 2015 conducted by CDC shows that persons living with diagnosed HIV
infection who are not in medical care, including the persons unaware of their HIV status are
responsible for 91.5% of newly diagnosed HIV infections; and persons living with diagnosed
HIV infection that are in care and receiving ART are responsible for the less than 6% of persons
46
newly diagnosed with HIV infections. In the United States, 9 out of 10 new HIV infections could
be prevented through establishment of HIV Care Continuum model17.
For the 2014 Memphis TGA HIV Continuum of care, three datasets were used to calculate the
number of people at each stage of care. The Electronic HIV/AIDS Reporting System (eHARS)
provided prevalence and lab information; Tennessee AIDS Drug Assistance Program (ADAP)
and CAREWare database provided usage of antiretroviral therapy; CAREWare database also
provided additional lab information for the Ryan white part A clients in Crittenden Arkansas,
and the four counties which are Marshall, Tate, DeSoto, and Tunica in Mississippi. As outlined
in Table 2-2, PLWHA in the three counties in the West Tennessee account for 88% of PLWHA
in the Memphis TGA, and 89% of new HIV cases were diagnosed in these three counties in 2014
(Map 2-3). Due to the limitation of accessibility of the eHARS data for the counties of
Mississippi and Arkansas, the stages of HIV continuum of care were calculated for the Shelby,
Tipton, and Fayette counties based on the Tennessee eHARS data, ADAP and the antiretroviral
therapy in CAREWare database. Since 88% of the PLWHA reside and 89% of new HIV cases
diagnosed in the West Tennessee three counties in the Memphis TGA, the percentage measures
the stages of HIV care continuum reflect the stages of HIV care continuum in the Memphis
TGA.
Different research studies present the stages of the HIV care continuum in different ways. The
definitions of each stage and calculation methods are vary. Memphis TGA used both methods
and definitions, which are CDC developed for calculating the percentages of each stage of HIV
care continuum18 for all infected persons living in the West Tennessee and HRSA recommended
stage of HIV care continuum19 for the DHHS (the U.S. Department of Health & Human
Services) funded HIV programs and Services in order to be able to effectively compare local
data with national data.
Definitions of each stage of Continuum of care by CDC developed method
Estimated HIV Infection: Estimated HIV infection is calculated by adding the number of
persons living with HIV/AIDS to the persons unaware of their HIV infection status. This
estimation is based on the latest CDC data of 86% of diagnosed and 14% of unaware of their
HIV infection status.
Diagnosed: Number and percentage of people living with HIV/AIDS in the EMA/TGA
diagnosed with HIV/AIDS.
Linkage to HIV Medical Care: determined by using lab values in Tennessee eHARS database
for the three counties which are Shelby, Tipton, and Fayette. If a person had a CD4 or viral load
test within 90 days of his/her initial HIV diagnosis he/she was considered to have been linked to
HIV medical care. This is not a measure of whether or not a person is linked into the HIV system
of care, meaning he could have received a medical or support service; it is solely a measure of
whether or not a person was linked into the HIV medical system within three months.
Retained in Care: the percentage of diagnosed individuals who had two or more documented
viral load or CD4+ tests, performed at least three months apart in the observed year.
47
Prescribed Antiretroviral Therapy (ART): the percentage of people receiving medical care and
who have a documented ART prescription in their medical records in the observed year.
Viral Load Suppression: calculated using the viral load laboratory test results recorded in
eHARS. Percentage of individuals whose most recent HIV viral load within the observed year
was less than 200 copies/ml.
According to the back calculation method CDC developed, of the 8,485 people living with HIV
in the Memphis TGA in 2014, an estimated 86% (n=7,297) were diagnosed. This means that
14% (approximately 1 in 7 people living with HIV) were unaware of their infection and therefore
not accessing the care and treatment they need to stay healthy and reduced the likelihood of
transmitting the virus to their partners.
In addition, people living with HIV are dropping off at every subsequent stage in the continuum.
Of the 8,485 people living with HIV in 2014, 51% were engaged in HIV medical care, 34% were
prescribed ART, and 47% had achieved viral suppression (Figure 6-1). One challenge in
calculating the continuum of care remains that we can best document ART prescription status for
Ryan White Part A clients, but 45% of PLWHA in the Memphis TGA are not Ryan White
Clients. Those infected in the TGA who receive their care privately can be documented to
achieve viral suppression, but not all data about their medical care is available. We are able to
observe however that 53% of people living with HIV in the Memphis TGA did not have their
HIV infection under control. Although the percentage of viral load suppression (47%) among the
people living with HIV in the Memphis TGA in 2014 is higher than the National average of viral
load suppression (30%) in 2011, more than half of the people infected with HIV are at risk to be
continuously transmitting HIV to others. In other words, according to the CDC continuum of
care study, more than 90% of new HIV infections are attributable to those who did not achieve
viral load suppression.
Figure 6-1. HIV Care Continuum in the West TN three Counties, 2014
Source: Enhanced HIV/AIDS Reporting System (eHARS), TN., CAREWare, ADAP, TN
48
Memphis TGA Ryan White HIV/AIDS Program Clients
Memphis TGA Ryan White Part A program grantees have been required to report client-level
data covering demographics, services and clinical information annually to the Health Resources
and Services Administration (HRSA) since 2009. In 2014, Memphis TGA Ryan White Part A
HIV/AIDS program served a total 3982 clients. Of these, 3,612 (91%) clients resided in Shelby
County, Tennessee (Figure 6-2). Crittenden County in Arkansas and DeSoto County in
Mississippi each have 2% of Ryan White clients. Rest of the clients (5%) resided in other
counties in the Memphis TGA.
Figure 6-2. Ryan White HIV/AIDS Program clients by County, Memphis TGA, 2014
Data Source: CAREWare, TN
Of all Ryan White Memphis TGA clients, there were 65.4% males, 34% females, and 0.7%
(n=26) transgender (including male-to-female and female-to-male) (Table 6-1). Age group 0-19
years old accounted for 2% of the Ryan White clients, followed by age group 20-24 years old
(6%), 55+ years (16%), 25-34 years (23%), 45-54 years (25%), and 25-44 years (26%). The adult
age group 25-54 years old accounted for 74% clients.
The racial/ethnic groups represented most commonly include black (85%), white (9%),
Hispanic/Latino (2%), and 4% for all other racial/ethnic groups.
49
Table 6-1. Ryan White HIV/AIDS Program clients, Memphis TGA, 2014
Total Clients
Sex
Male
Female
Trans Gender
Age Group (as 2014)
0 - 14 years
15 – 19
20 – 24
25 – 34
35 - 44
45 - 54
55+
Missing
Race/Ethnicity
Black or African-American
White (non-Hispanic)
Hispanic/Latino
Other Races
Frequency
3982
Percent
100%
2603
1353
26
65.4%
34%
0.7%
31
41
228
913
1034
992
640
103
1%
1%
6%
23%
26%
25%
16%
3%
3398
349
77
158
85%
9%
2%
4%
Source: CAREWare, TN
Continuum of HIV Care: Memphis TGA Ryan White Part A HIV/AIDS Program Clients
HRSA recommended definitions for the each sequential stage of Continuum of HIV Care for the
DHHS (the U.S. Department of Health & Human Services) funded HIV programs and Services
are outlined in (Table 6-2).
Table 6-2. Continuum of HIV Care Definitions (HRSA)
Numerator Definition
RW client
Received RWfunded medical care
or case management
and HIV+
RW-funded medical
care
Retained in medical
care
ART
Client received at least 1 RW-funded
service in calendar year
[Includes HIV+, HIV-negative, HIVindeterminate]
Client received RW-funded medical care
or case management services and was
documented to be HIV+
Denominator Definition
(for proportion)
Not applicable
RW client
Received RW-funded medical care
RW client
Attended at least 2 RW-funded medical
care visits that were at least 90 days apart
RW-funded medical care
and had visit date
available
and had ART data and
visit date available
Received ART prescription at any time in
the year
50
Viral load
suppressed
HIV-1 viral load <200 copies/ml for the
most recent value reported
and had viral load
available
Data Source: http://hab.hrsa.gov/data/reports/continuumofcare/continuumdefinitions.html
Continuum of HIV Care: Results Ryan White-Funded Medical Care
During the calendar year 2014, of all 3,982 Ryan White (RW) part A served clients, 92% clients
received at least on medical care visit in the 12-months measurement period; 89% (n=3,532)
RW clients for whom HIV+ status is documented received at least one medical care visit
(either medical care or case management services) in the 12-months measurement period and
viral loads or CD4 laboratory test results available (Figure 6-3). Of the 3,532 (89%) HIV+
individuals who received RW-funded medical care, and had visit dates available, 2,894 (73%)
clients were retained in medical care (at least 2 medical care visits at least 90 days apart).
Figure 6-3. Continuum of HIV Care among Ryan White HIV/AIDS Program clients,
Memphis TGA, 2014
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN., CAREWare, ADAP, TN
Continuum of HIV Care: Antiretroviral Therapy
There were 2,894 individuals who received RW-funded medical care and attended at least 2 RW
funded medical care visits that were at least 90 days apart (Figure 6-4). Of these, 2,109 (73%)
were prescribed Antiretroviral Therapy (ART).
51
Figure 6-4. Antiretroviral Therapy (ART) among Ryan White HIV/AIDS
Program clients, Memphis TGA, 2014
Continuum of HIV Care: Viral Load Suppression
There were 2,774 individuals who received at least one RW-funded medical care visit and had
viral load data available (Figure 6-5). Of these, 2,181(82%) had viral load <200 copies/ml at the
most recent test. Individuals retained in medical care had a higher proportion with viral load
suppressed (79%) compared with individuals who were not retained in care (62%).
Figure 6-5. Viral Load Suppression among Ryan White HIV/AIDS Program clients,
Memphis TGA, 2014
52
The relationship of engagement of care and achieved viral load suppression among the Ryan
White part A clients is shown in Table 6-3. Although the proportions of engagement of care
were similar among the age groups, the proportion of achieved viral load suppression among the
age group 35 years old and above is higher than those among the age group 15-24 years old. The
age group 15-19 and 20-24 years old have achieved lowest proportion of viral load suppression
(72% and 70% respectively) compare to the older age group 35+ years old who have achieved
84% viral load suppression. This finding highlights the importance of long term engagement of
care and treatment in order to achieve a higher level of viral load suppression.
Table 6-3. Engagement of Care and Achievement of Viral Load Suppression among the
Ryan White part A Clients, Memphis TGA, 01/01/2014 – 12/31/2014
Current
Age
Group (as
of 2014
Total
0 - 14
15 - 19
20 - 24
25 - 34
35 - 44
45 - 54
55+
Missing
RW
Clients
*Engaged in
Care (N)
*Engage
d in Care
(%)
3,982
31
41
228
913
1,034
992
640
103
3,532
22
40
194
800
926
886
575
89
89%
71%
98%
85%
88%
90%
89%
90%
86%
**In RWmedical
care and
VL
2,774
22
39
168
624
703
689
464
65
***VL
Suppression
2,281
18
28
117
496
589
583
391
59
***Achieved
VL
Suppression
(%)
82%
82%
72%
70%
79%
84%
85%
84%
91%
*Received at least one medical care visit in the 12-months measurement period and VL or CD4 available
**Attended at least 2 RW-funded medical care visits that were at least 90 days apart
*** Viral Load Suppression (VL<200 copies/ml)
Continuum of HIV Care: Conclusions
In Memphis TGA, at the end of 2014, there were estimated 8,485 persons living with HIV
disease. Of these, Ryan White HIV/AIDS part A program served almost 4,000 individuals living
with or affected by HIV.
Of the HIV+ Ryan White HIV/AIDS Program clients who received RW-funded medical care:



82% were retained in medical care compared to 51% of all estimated PLWHA in Memphis
TGA.
73% were prescribed antiretroviral therapy compared to 34% persons were prescribed
antiviral drug.
82% had viral load suppressed compared to 47% people achieved viral load suppression.
The proportion of retention, ART prescription, and viral load suppression among the RW part A
served clients are high compared to the proportion of those all PLWHA in the Memphis TGA.
This achievement highlights the successfully implementation of the Ryan White Treatment ACT.
53
Both method of calculating the Continuum of Care in the Memphis TGA have demonstrated
room for improvement. These improvements will help to achieve the goals of the National
HIV/AIDS Strategy and improve individual and public health.
54
ASSESSMENT OF SERVICE NEEDS AND GAPS
There were two methods used to assess service needs and gaps: a consumer survey and a
provider survey. The consumer survey was given primarily to in-care individuals, but a special
Community Research Assistant was contracted with specific responsibility to access the out-ofcare community and survey them.
1. Consumer Survey
Method
The Priorities and Comprehensive Planning Committee designed a survey to be conducted on the
Survey Monkey website for ease of data collection and analysis. Six Community Research
Assistants were contracted to survey consumers at the various providers’ locations. Some
providers requested that they conduct the surveys in-house using their own staff. This accounted
for 61 of the surveys, about 13.5% of the total. There were 451 total instances of the surveys
being started, and about 421 completed surveys. Only completed surveys were included in
analysis due to the potential for duplicative data if the survey had been stopped and restarted in a
different session, for instance.
Consumers had the opportunity to question meaning of any question on the survey with the
Community Research Assistants or with the in-house providers. Of the 451 total responses, about
30.2% were captured from out-of-care consumers. Collection of responses ran from March 23,
2015 through April 27, 2015.
Analysis
The survey data was analyzed using Microsoft Excel and the built-in functions statistical
functions of the website Survey Monkey.
Demographics
Residence
The respondents were overwhelmingly (91%) from Shelby County. 5.9% were from Crittenden
County, and one percent or less were from other counties in the TGA.
Housing
The survey captured that 76.72% of consumers were stably housed, 18.05% temporarily housed,
and 5.94% were in unstable housing.
Age
Dealing with age, most consumers were aged 45-64 who took the survey.
55
Table 7-1. Age Groups of Consumer Respondents
Age Group
Response Percent
Under 2
2-12
13-24
25-44
45-64
65 or older
Decline to respond.
0.5%
0.0%
4.8%
34.4%
58.7%
1.7%
0.0%
Source: Survey Monkey, 2015 Needs Assessment
Sexual Orientation
An interesting response was that 61% reported they were straight. We believe that there is a high
likelihood that this is due to the continuing stigma that exists in the TGA against openly
identifying as gay.
Figure 7-1. Sexual Orientation of Survey Respondents
Self-reported Sexual Orientation
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Straight
Gay or lesbian
Bisexual
I don't identify as
any of these.
Decline to
respond.
To assess whether a consumer was transgender, we utilized a three-question methodology, first
querying the consumers’ sex at birth, then their self-identified gender, and finally, if transgender
or gender non-conforming, probing about the specific identity.
56
Figure 7-2. Sex at birth of Survey Respondents
Sex at birth
0.2%
Male
33.7%
Female
66.0%
Decline to
respond.
Figure 7-3. Gender identity of Survey Respondents
Gender identity
1.4%
0.2%
0.0%
Decline to respond.
Male
Female
33.7%
64.6%
Transgender, transsexual,
or gender nonconforming
I do not identify as any of
these.
All six of the transgender/transsexual/gender non-conforming individuals identified as male to
female transgender/transsexual.
Ethnicity
Six respondents (1.4%) identified as Hispanic.
Race
The great majority of respondents identified as Black/African American (91.4%) or
White/Caucasian (7.1%).
57
Figure 7-4. Race of Survey Respondents
Race
American Indian or
Alaskan Native
0.0%
1.2%
Other (please
specify)
1.2%
Native Hawaiian or
Pacific Islander
0.0%
Black/African
American
7.1%
Asian
91.4%
White/Caucasian
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Relationship Status
The majority of the respondents were single.
Table 7-2. Relationship Status of Survey Respondents
Relationship status
Response Percent
Single
63.7%
Married
7.8%
Living with partner
7.4%
Widowed
1.7%
Separated
4.5%
Divorced
5.2%
Have a steady partner but not living together
9.0%
Decline to respond.
0.7%
Employment
No single majority employment status existed. However, 75.5% of respondents were not
members of the workforce.
58
Table 7-3. Job situation of Survey Respondents
Job situation
Response Percent
Disability
39.9%
Retired
1.2%
Self-employed
1.7%
Student
3.1%
Unemployed and looking for work
21.1%
Unemployed and not looking for work
10.2%
Working a full-time job
10.0%
Working off and on
3.8%
Working a part-time job
8.6%
Decline to respond.
0.5%
Education
Educational attainment of possessing a high school diploma but not a college diploma describes
65.5% of our consumers taking the survey.
Table 7-4. Educational Attainment of Survey Respondents
Educational Attainment
Response Percent
Less than high school
23.8%
High School Graduate or GED
38.7%
Some college or vocational school
26.8%
College Graduate (Bachelor’s Degree)
5.5%
Graduate degree (Master's Degree, Doctorate,
1.7%
MD, PhD)
Decline to respond.
0.2%
Other (please specify)
3.3%
Diagnosis
Reflective of the aging population we serve, 56.1% of our consumers in the survey reported their
diagnosis as having occurred over ten years ago.
59
Figure 7-5. Time since HIV Diagnosis of Survey Respondents
1.2%
How long ago were you diagnosed with HIV?
2.9%
12.8%
Less than 1 year ago
1-3 years ago
4-6 years ago
6-10 years ago
Over 10 years ago
Decline to respond.
12.4%
56.1%
14.7%
Among the respondents, 13.1% report having been diagnosed with AIDS, with 54.5% of those
reporting having been diagnosed with AIDS over 10 years ago.
Core Service Needs
The strongest needs voiced by consumers were those of Oral health, Medical nutrition therapy,
Mental health services, Home health care, Home and community-based health services, and
Health insurance premium and cost-sharing assistance for low-income individuals. We feel that
oral health, which is traditionally uses near-to-all of its funding yearly, may need to be examined
for expansion of funding or of the funding cap which limits consumers presently. We felt that
home health care and home and community-based health services needed further study to ensure
both we as the grantee and the consumers understand its intents and uses.
Table 7-5. Core Service Utilization of Survey Respondents
Core Service Categories
I get
service
AIDS drug assistance
program
AIDS pharmaceutical
assistance
Early intervention services
Health insurance premium
and cost-sharing assistance for
low-income individuals
51.7%
I need
I need
but don't but don't
get
know
service
about
service
4.3%
2.6%
I don't need this service
41.4%
58.8%
3.8%
5.0%
32.4%
42.1%
70.6%
4.8%
7.6%
5.6%
6.2%
47.5%
15.5%
60
Home and community-based
8.6%
8.6%
4.1%
health services
Home health care
3.9%
8.7%
1.7%
Hospice services
4.1%
1.9%
1.9%
Medical care (Outpatient and
91.2%
4.0%
1.7%
ambulatory medical care)
Medical case management,
73.6%
3.3%
1.4%
including treatment adherence
services
Medical nutrition therapy
42.6%
12.7%
3.6%
Mental health services
27.5%
11.2%
1.2%
Oral health
67.0%
15.9%
4.8%
Substance abuse outpatient
8.5%
4.3%
0.7%
care
78.7%
85.8%
92.0%
3.1%
21.7%
41.1%
60.0%
12.3%
86.5%
Supportive Service Categories
Consumers voiced the most need for the service categories of Emergency financial assistance,
Housing services, Food bank/home-delivered meals, Medical transportation services, Legal
services, Outreach services, Referral for health care/supportive services, Health education/risk
reduction, and Psychosocial support services. Of these, “basic need” type services were
requested by 23.1%-33.3% of respondents. After analysis, we felt that consumers likely did not
understand the functional services for legal or outreach. The high percentage (14.2%) of
consumers voicing needing and/or not knowing about referral services, coupled with the provider
survey responses, highlights the need for more education amongst both the consumers and
providers about services available for HIV-infected individuals. The positioning of medical
transportation here, in the barriers question, and in the providers’ survey makes a clear point of
the need of more, and perhaps innovative, options to get consumers to their service locations.
Table 7-6. Support Service Utilization of Survey Respondents
Supportive Service Categories
Case management (non-medical)
Child care services
Emergency financial assistance
Food bank/home-delivered
meals
Health education/risk reduction
Housing services
I get
I need
I need
service but don't but don't
get
know
service
about
service
62.0%
6.7%
1.0%
I don't need this
service
30.4%
1.4%
19.7%
38.0%
3.8%
33.3%
23.1%
1.0%
13.9%
7.2%
93.8%
33.1%
31.7%
39.6%
15.6%
9.7%
24.5%
2.7%
7.7%
48.1%
52.3%
61
Legal services
3.9%
13.3%
1.7%
Linguistics services
0.5%
1.2%
0.5%
(interpretation and translation)
Medical transportation services
35.2%
18.3%
4.6%
Outreach services
35.3%
12.1%
4.1%
Psychosocial support services
35.6%
9.3%
6.9%
Referral for health
50.4%
11.8%
2.4%
care/supportive services
Rehabilitation services
8.0%
6.0%
1.2%
Respite care
0.7%
0.7%
2.9%
Substance abuse services—
3.8%
2.6%
0.2%
residential
Treatment adherence counseling 17.0%
4.1%
0.7%
81.2%
97.8%
41.9%
48.6%
48.1%
35.4%
84.8%
95.7%
93.3%
78.2%
Barriers
Almost one-fifth of respondents said they were unable to receive needed services due to lack of
transportation. More than one-tenth didn’t know where they could get services, again pointing to
a need of education on available services.
Table 7-7. Barriers of Survey Respondents
Barriers
This doesn't apply to me. I got the services I needed during
the past 12 months.
Response Percent
60.3%
I couldn't get transportation.
I didn't know where to get services.
I couldn't pay for services.
I didn't want people to know that I have HIV.
19.7%
10.5%
8.6%
7.8%
7.1%
I was depressed.
I was homeless.
I didn't feel sick.
I don't feel the provider location protects my
confidentiality.
I was too busy taking care of my partner, family, and/or
children.
I couldn't get time off work.
I couldn't get an appointment.
I had a bad experience with staff at the provider's office.
6.9%
5.7%
4.8%
3.6%
I couldn't get childcare.
I was afraid of partner abuse or domestic violence.
1.2%
0.0%
3.1%
2.4%
2.1%
1.9%
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Cultural competency
We assessed fifteen areas of cultural competency from both the consumer and provider point of
view. Interestingly, the consumers were less critical of providers than the providers were of
themselves, with at most about 4% disagreeing about being treated with respect and/or
understanding in the different aspects of cultural competency.
Table 7-8. Cultural Competency per consumer respondents
“Providers respect and
I agree
I neither
I disagree
understand me in
agree nor
regards to...”
disagree
The amount of money I
79.9%
7.0%
4.1%
have
Other illnesses, including
83.3%
3.6%
3.6%
mental illnesses, that I
have
The community I'm from
86.8%
4.1%
3.1%
The people I am attracted
83.0%
5.7%
3.1%
to or have sex with
The appropriate way to
89.2%
4.3%
3.1%
address me and talk to me
The type of place I live in
85.9%
4.8%
2.9%
My educational level
89.6%
3.9%
2.4%
My race
91.4%
2.9%
2.2%
My religious beliefs or
86.8%
4.8%
1.9%
lack of religious beliefs
The type of job I have
51.2%
3.6%
1.2%
My HIV status
92.6%
2.9%
1.2%
The gender I express
91.4%
1.9%
1.0%
My age
92.6%
2.9%
1.0%
My language, if it's not
38.2%
2.2%
0.7%
English
Who I live with
70.3%
4.3%
0.7%
This doesn't
apply to me
9.1%
9.5%
6.0%
8.1%
3.3%
6.4%
4.1%
3.6%
6.5%
44.0%
3.3%
5.7%
3.6%
58.9%
24.6%
Medication adherence
Over two fifths of respondents reported missing no doses of their medications. In a separate
survey question, 75.8% reported having taken all their medication over the past seven days prior
to the survey. “Simply forget” accounted for over one quarter of forgotten medication doses.
Stigma again presented itself as a barrier for 5.5% of respondents who did not want others to
know they were taking HIV medication.
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Table 7-9. Medication Adherence of Survey Respondents
Answer Options
I didn't miss any doses.
Simply forgot
Ran out of pills
Was away from home
N/A - I don't take HIV medications.
Had a change in daily routine
Wanted to avoid side effects
Had problem taking pills at specified times
Did not want others to know I was taking HIV medication
I didn't pick up medication when it ran out
I needed to take pills with food and didn't have food
I didn't want to think about HIV
I didn't have transportation to get my medication
Had too many pills to take
Felt good/felt healthy
Response Percent
41.8%
29.0%
13.5%
9.3%
9.0%
8.1%
5.9%
5.5%
5.5%
5.5%
4.5%
4.0%
3.6%
3.6%
2.1%
1.2%
Incarceration
Of the survey respondents, 22.6% had spent some time in jail or prison since their diagnosis of
HIV with over a third spending more than a year incarcerated. The largest subset, 36.8% had
been released over six years ago. 82.1% received HIV/AIDS medical care while incarcerated.
About one-third of formerly incarcerated respondents reported getting referrals to medical care,
housing, case management, and a week’s supply of medication upon release. Over half were also
able to find stable housing within a month of release and 76.8% accessed medical care in less
than one month. Again, barriers were no transportation (8.4%,) didn’t know where to go (7.4%,)
and not wanting to be known as HIV-infected (6.3%,) mirroring the triad of problems seen in the
general TGA population.
Limitations
There were two main limitations of the survey. The first was a problem with inconsistent data
that was obtained by a specific person administering the survey. The problem was determined to
be a lack of understanding of the consumers’ responses due to a language barrier. This led to the
need to discard 49 surveys. Secondly, we had calculated a need to obtain approximately 830
surveys to adequately sample our consumer population. We were able to get 451 responses, 421
being complete after the discarded surveys.
2. Consumer Focus Group
Method: The qualitative portion of the comprehensive needs assessment included three (3)
focus groups with MSM (Men Having Sex with Men), youth and residents of Northern
Mississippi sub-populations. This qualitative research method was used summarize common
themes emerging from concerns with consumers in the TGA. Participants of the focus groups
64
were invited based on their interest in participating as noted from completing the consumer
survey. Semi-structured interview questions developed were developed from review of previous
needs assessments and discussions with the Priorities and Comprehensive Planning Committee
and MSM Taskforce of the HIV-Care and Prevention group. Questions were asked to engage
consumers in discussions relative to better understanding services, barriers to care, cultural
competency, prevention education and suggestions to improve HIV services in the community.
Each focus group session were moderated by consumers and/or from support staff from the
Planning Group support staff.
During May and June, participants were contacted by phone to participant in focus groups.
Participants were informed on the logistics, the availability of dinner/lunch, transportation
reimbursements, incentives and other special accommodations as needed. Participants of the
North Mississippi focus group were transported to Memphis by a case manager in order to
participate in the focus group. Emails were sent and remainders were sent 2-3 days prior to
sessions. Table 8-1. below provides an overview of the each focus group logistics.
Table 8-1. Focus Group Logistics.
Date
Location
MSM
May 29th
The Haven
Youth
June 9th
St. Jude
Time
6:00pm
3:00pm
$20 Gift Card
$20 Gift Card
Lunch
Lunch
Transportation
Reimbursement
*Facilitated by H-CAP member
**Memphis TGA clients invited to attend, not included in results.
Incentives
Northern MS
June 11th*
Church Health CenterWellness
12:00pm
$20 Gift Card
Lunch
Analysis: Focus groups ranged for one-two hours and all activities were audio taped.
Transcriptions were completed verbatim by Planning Group Support staff and notes were taken
by the moderator as each session. At the end of each session, all transcripts and notes were
reviewed to ensure the accuracy prior to analyzing. Data analysis included coding text to identify
common themes and key insights to compare each section of questions from the three focus
groups both as individual sections and one as a whole to understand participants’ perceptions. A
draft of the analyses was reviewed by the Priorities and Comprehensive Planning committee and
the summary of findings was presented to the HIV-Care and Prevention Group.
Findings from MSM Focus Groups
Demographics: The demographics of the focus group participants are identified in Table 8-2.
below.
65
Table 8-2. Characteristics of Focus Group Participants
MSM (N=14)
County
 Shelby: 79%
 Fayette: 21%
 DeSoto: 7%
Age Group
 13-24 years old: 29%
 25-44 years old: 43%
 45-64 years old: 29%
Race
 African American: 93%
 White/Caucasian: 7%
Youth (N=7)
County
 Shelby: 86%
 Fayette: 14%
Sexual Identify
 Male: 72%
 Female: 14%
 Transgender:14%
Age Group
 13-24 years old: 71%
 25-44 years old: 29%
Race
North Mississippi Residents (N=6)*
Sexual Identify
 Male: 17%
 Female: 83%
Age Group
 25-44 years old: 33%
 45-64 years old: 67%
Race
Education
 High School Graduate: 14%
 Some College/School: 57%
 College Graduate: 29%
Employment
 Disability: 14%
 Unemployed: 21%
 Employed: 36%
 Student: 29%
Housing
 Temporary: 29%
 Stable: 71%
Education
 Some College/School:43%
Employment
 Unemployed: 14%
 Employed: 57%
 Student: 43%%
Housing
 Stable: 100%
Education
 < than High School: 33%
 Graduate Degree: 17%
Employment
 Disability: 67%
 Employed: 33%
Housing
 Temporary: 33%
 Stable: 67%
*(Participants of the North Mississippi focus group included fifteen clients of which Shelby
County residents were invited to meet and discuss services in the Mississippi Counties. Though
all clients were encouraged to participate in the focus group, the results only contain comments
from those in North Mississippi.)
66
Community Education: Participants were asked about the most important issues faced with
people living with HIV in the Memphis TGA. Responses such as being an advocate, getting
better assistance from agencies, disclosing HIV status, knowing of resources to care for self,
housing, mental health, and stigma were commonly discussed during the focus group session.
MSM participants addressed housing concerns by stating:
“I tried and tried to get my own [housing] because I’m tired of being homeless…I was
homeless for two years and never got any assistance so I used my income and went ahead
and got my own housing so I’m not worried about housing anymore even though I need
to find a better house than where I’m at because I’m not satisfied there.”
“There’s so many people who have no understanding of different mental disorders and
the different kind of ways to deal with the different people. It’s a lot of people that work
in the mental health profession and they have no training in psychiatry and they want to
make an estimate…estimate on somebody as far as what’s wrong. They want to put a
label on you or put a diagnosis on you, they have no qualifications to do so and I think
that is something that I believe people need to be trained a little bit, especially when it
comes in contact with people with mental disorders.”
Residents in North Mississippi talked about drugs and alcohol being an issue in their community.
They felt that community members are not informed on the various outcomes when engaging in
sexual risk behaviors. Many referred to residents not being aware of spreading sexually
transmitted diseases and knowing how to prevent it. A few residents mentioned:
“The fact when you see teenagers out here doing it, having sex for money and getting on drugs
and ain’t nobody…you know telling them that this disease is out here…you need to be a little bit
more careful and use more protection to prevent from getting it yourself…some of us around
here got it now and don’t even know.”
“ A lot of young folk are homeless and they don’t understand that you can’t be out doing any and
everybody.”
Respondents from the youth focus group reported unprotected sex as an important issue within
their community; but also related it to being open and disclosing HIV status. As noted by one
youth, “I would just say people’s opinions about sex [is a big concern] because like during sex or
even before it even start, if you attracted to this person or feeling this person, you not fixin’ to be
like oh put a condom on cause you afraid that he might turn around and turn you down or he
gonna ask do you even got something…” Other respondents shared similar experiences:
“I still use a condom …even if I disclose it, I still want to use a condom. And I feel like if you
disclose it in the beginning of the relationship, you can save yourself from getting hurt.”
“I say gone and tell them, hey look, I have this or I got his going on with me or whatever the case
might be...gone and tell them so you won’t get hurt in the long run…it can be like three years
down the road, you just taking control of your sexual health.”
“I’d rather just gone and say something cause I want to be protected on all frames or whatever
versus oh ok I’m just going to do it this one time or whatever and then that one time comes along
67
with another, then another and that’s how we get in these situations…we need to start telling the
truth.”
Ryan White Services: Psychosocial support services, oral health, transportation, Insurance
Assistance Program, food bank services, were cited as most satisfied Ryan White services
amongst majority of participants. MSMs expressed satisfaction with several Ryan White services
and expressed the following comments:
“ I couldn’t afford my medicine, but I talked to a case manager and now I get all my
medicines.”
“I’m satisfied with all my Ryan White services.”
“I’m just glad I can get my medicines, food, help with transportation and basic medical
care from my provider.”
Alike, others from focus groups mentioned being satisfied with outpatient services and food bank
services. As stated by one, “I use food pantry and things of that nature but I will say that
outpatient care at this provider has definitely been everything and more. Another service is case
management; my case manager helps me with everything, she is awesome.” Other comments
included:
“My case manager makes sure I go to my appointments….and most times we go together….she
like come on, come on, let’s get some help baby.”
“I just love her, she is consistent.”
“From day one, my case manager was up front; she take me to the doctor and say this is this and
you need to do that…..she is direct and I just love that about her; she knows how to talk to me
and tell people stuff and she do a lot of referring.”
When asked about least satisfied Ryan White services, all groups discussed housing. Many noted
not really understanding the Ryan White housing program and how it differ from other housing
resources in the community, which resulted in their feelings of not being satisfied. One
respondent shared an experience that very well summarized several of these themes discussed
during the focus groups:
“I applied for housing three years ago and they finally called me and asked if I were still
interested...so I wonder if they do everyone that apply like this and it took this long…once
settled, they only offered me limited assistance in my rent because become of my income…I
don’t understand that.”
Discussing a similar experience, another respondent noted feelings of concerns when addressing
housing:
“ It took three month…three months in a long time to try to find housing when you know you
need assistance….when you find something you just can’t jump on anything, you got to make
sure it fits your lifestyle.”
68
Cultural Competency: When asked about elements around personal identification, thoughts,
communication, customs belief, effects on HIV health care, health information and client’s
ability to access services, participants identified both positive and negative statements. While
most participants felt that providers were respectful and responsive to the delivery of HIV
medical and supportive services, some noted differences because of other aspects of health care
needs. Discussing the experience around feelings with HIV providers, MSM participants stated:
“They want to put a label on you or put a diagnosis on you…they feel like that have
qualifications to do so and I think that is something that people need to be trained on a little bit
and have better contact with people with mental health disorders.”
“Because I’m visually impaired, people don’t want to bothered, they don’t way to read things to
you, they don’t want to assist you, it’s almost like they don’t want you.”
“Overall, I don’t feel like I’m treated differently uh, it’s a certain way I carry myself so I’m
treated well.”
“ I talk to their supervisor and tell them [how I was treated] because I don’t feel pressed.”
North Mississippi residents shared positive care experiences relative to their providers. There
were instance in which respondents reported provider behavior as being welcomed, pleasant,
respectful, flexible and being able to meet at untraditional times in order to accommodate needs.
Comments for participants included:
“They love us…they there [for us]. You need that tough love but they always there. [We] pick up
the phone and call…they always there.”
“When it get a little difficult for us to deal with, we have connections where we can reach out to
them…we have that one on one connection.”
“They communicated with us… they know what we going through, these two right here I
commend y’all to the upmost.” [referring to providers]
Youth respondents also shared positive statements when referring to feeling of being welcomed,
comfortable or motivated by an agency:
“I’ve been treated like family honestly.”
“They quick to call you up if you miss an appointment. They will call you and send you letters.
One youth reported feeling uncomfortable when his medical information was not held as
confidential. He detailed an encounter with a provider in which he entered into the agency,
introduced him as he checked in and immediately discovered he was treated different because of
his status. He felt unwelcomed as he described, “some lady came in and they was just talking
about me like I wasn’t even there and I was like… I got to go. Not once did they try to stop me
from leaving. “
Across all focus groups, participants weighed in on topics they would like providers to cover in
regards to their sex life. For instance, MSM participants discussed having children and stated
69
“As a gay male, at some point I would really love to have my own blood bank…I think being
able to talk to or being able to talk to a provider about possibly sperm washing or conceiving a
child with a negative woman or even a positive woman…or you know kind of what options and
if it really can be done…just give me basic statistics on the possibilities.”
Though not a sexual well-being question, participants in the youth focus group discussed having
providers speak more on health insurance coverage and Ryan White services after aging out at
St. Jude. All agreed having a clear understanding after aging out care would be helpful when
preparing to transition from one agency to another.
Barriers to Care: To understand reasons for not seeking medical care and ways of making it
easier for people to get services need to stay in care, participants reported several factors that
fostered barriers to care for positive individuals. Fear was noted as the number one barrier,
followed by stigma, depression and low self-esteem. Participants raised concerns about denial, in
which one client reported:
“Some folk just don’t believe they have it. They haven’t come to the point that they actually have
it or think they can take care of it on their own.”
Participants also raised concerns about lack of knowledge with available resources. In discussing
this, one respondent said:
“Sometimes people just don’t know that care is free if they can’t afford it. They don’t know that
once you go to a provider to get checked out and test positive they gone reach out to you because
they want to help. The nurses at my agency and the health department gave me some good
connections.”
Another respondent talked about providers and the office location as a barrier while comparing
the situation to visiting a private doctor location. The respondent noted that some prefer the
private doctors as oppose to public health facilities because of the possibility of being labeled as
“positive”. Discussing how he felt about the situation, he mentioned:
“See when you go to a private doctor, you go for care; When you go to Friends ( for Life) who
got the knowledge for instance, it’s just for someone that has HIV. But when you go to Memphis
Health Center, it was open for everybody….like if you had a broke[n] arm, they don’t know
what you are there for.”
Also in discussing barriers, participants mentioned wait time at the offices being too long and
inconvenient, resulting in clients leaving before seeing a doctor and/or nurse. Confidentiality was
also noted as a barrier care for someone newly diagnosed. Being able to hide and not expose
medications in public was explained by one client:
“When you a client, it can be hard trying to conceal your medications while being in care if you
are seen in certain places…you don’t want to be the one where people start asking you, what
kind of pills is that and then have to hide them here, hide them there and then go [back to] get
them….so they will say I’m tired of hiding so ain’t so sense of taking them, I’m just not going to
take them. Then nobody has to worry about seeing and finding them [the pills] and asking them
questions.”
70
I went to that agency before with a friend and it took so long…when I tell you I was there for 13
hours….I was just sitting there…just sitting there waiting. It took so long to go and get care.”
Similarly when talking of reasons newly diagnosed individuals may not seek care, one
respondent noted:
“ Yeah, for instance I know folk who used to go that agency and they felt uncomfortable because
they [provider] was saying this and that and thinking they just fell… dropped completely out of
care….so I had to try and find them any private doctor to go to and get them back in care. See
the provider think it’s the HIV that they just stop going.”
Finally for many participants, housing was discussed as a major barrier to care, in addition to a
range of unfavorable experiences when trying to obtain services from providers and other
agencies in the community. From residents in North Mississippi, it was noted that:
“Yes, we lack housing, we have some slum housings like they are unlivable and we don’t want
to live in a shack. They want to set high price rent and we not gone go in no area when we are
uncomfortable.”
In other focus groups, many participants felt being homeless would cause one from seeking and
accessing care, which most agreed that if there were more housing options available, then a
PLWHA would be more likely to stay in care. As noted by participants:
“If someone is homeless, they ain’t worried about no medicines, appointments, not case manager
or nothing besides where they sleep and stay at night.”
“Like if I change my address, my case manager gone ask me about my housing situation and
why I switched my address from where I stayed to this [new] one….so you gotta go through a
little process and something I don’t even feel like all that.”
It’s hard being homeless and trying to keep up with your meds…cause people who move
locations a lot don’t have a permanent address or they can’t get reliable transportation to and
from different locations.”
Prevention: Participants were asked about their thoughts around HIV prevention and education
services offered within their communities and whether they felt confident in doing what is
needed to prevent transmission to a sex partner. Several participants expressed having ample
prevention education and willing to share information as needed to sexual partners. Many also
discussed that providers have held discussions detailing the process of acquiring information,
discussing beliefs about sex, sexual identity, intimacy and relationship factors. Comments from
all focus group participants included:
“I really like the place around town where you can get the free condoms…I just grab a handful
when I can.”
“I’m up front with them, I don’t sugar coat nothing… I tell them I’m HIV and if they don’t like
it, I’m fine with it.
71
“I’m like this, I’m comfortable in knowing what I have and I’m ok with sharing it and talking
about it with my dude, so if he feels some kind of way about it, that’s on him….I’m cool
knowing that I was upfront with letting him know what I got going on.”
Respondents were also asked about the ideal HIV prevention program for the MSM, youth and
North Mississippi residents in their respective communities. In addressing this question during
the MSM focus groups, a client suggested putting more sexual education program back in the
classrooms. This would encourage students to be more open in discussing sex and getting
information that would lessen sexually transmitted disease among the youth. He detailed the
suggestion by offering:
“I would hold rallies, have open forums, open mic sessions letting them freely come up to the
mic and express themselves on what they know, what they don’t know, the experience they have
had and other stuff. We would have talks about molestation, who did it and how it made you
feel…then talk about what they learned, what they want to share with others that are in a
situation and how they plan to help somebody else to be more knowledgeable and more aware.”
It [prevention] needs to be taught in schools...that’s part of the problem, it’s not talked about…it
only takes one time depending on a person being able to psychologically accept that you are
positive.”
“It needs to be more than just having a football or basketball coach talking about sex in
school…it needs to be someone that is qualified to teach it.”
“If it’s put back in the schools, parents need to get involved…try to get some of the kid’s parent
involved [in sex education].”
“I think that thing that work the best with college students is when we give the [HIV] test and it’s
an incentive attached…so even if you aren’t positive, you got a gift card too, not to put it in those
terms, but it was something attached to getting tested…so it may be comfortable or whatever to
at least know if that make sense.”
Suggestions for Improvement: In all focus groups, respondents recommended a range of
improvements that cluster in four (4) different areas.
Offer clients education on Ryan White services: Several improvements centered around
providing more education and training to clients on the available Ryan White services.
Suggestions included:



Explain housing eligibility through Ryan White to clients
Inform clients in what housing options are available
Discuss options with dental services and what services are covered through Ryan White
Offer provider-client relationship training: A few participants suggested improvements in
enhancing the relationship clients have with providers, which would help build more trust when
discussing medical and support services offered through Ryan White:

Offer provider training to assist in understanding needs of subpopulations (youth,
MSM and North Mississippi residents.
72




Encourage training on better listening, professionalism and communications
Seek opportunities to create interactive trainings about belief, social groups, personal
identification, etc.
Address ways to learn more about how subpopulations express stress, feelings,
various health symptoms.
Discuss ways to better know the clients beyond current health status’ more individual
time with providers during visits.
Enhance peer support: Participants expressed the need to include more peers in agencies, which
would allow for greater client use in various Ryan White services:


Include more MSM and youth on staff at agencies and in support focused activities.
Create more opportunities for peers to help other peers and seek out services.
Encourage client accountability: Some comments made during focus groups suggested the need
for clients to go an extra step and become more familiar Ryan White, its services and others
options available in the Memphis TGA. Participants recommended:



Inform clients of questions to ask provider, which could motivate them to taking
charge of health condition.
Assist clients in addressing barriers that may prohibit following a treatment plans
from providers.
Assist clients in understanding provider recommendations in order to engage in
healthy behaviors.
Limitations: During the three focus, each session posed challenges with analyzing the
qualitative data. Participants were a result of a convenience-based sample, which may not
represent the views of larger segments of the youth, MSM and Northern MS PLWHA
populations. Participants attended focus groups according to their availability including the time,
location and weekday in which meetings took place. While each session was recorded, some
parts were inaudible. The ability to recognize various participants for comments as well as the
difficultly to analyze comments due unstructured sessions also created limited challenges while
analyzing the contents within each focus group. To limit the impact of unintended outcomes and
the possibility of data from being skewed, the facilitator engaged in probing techniques and
encouraged participants to speak their mind, even when some felt unsure on how to address
questions.
Conclusions: Participants of focus groups provided feedback on Ryan White services by
commenting on both positive and negative as well provided suggestions for improvement to
consider in addressing various needs for clients. In discussing topics including the engagement of
consumers in discussions relative to better understanding services, cultural competency, barriers
to care and prevention education, participants concluded consistently felt being stigmatized
(based on special population) was an important issue to note when considering how to improve
HIV services in the community. Unprotected sex is still identifies as the most risky transmission
behavior, in which drug use continue to prevalent. Most agreed being most satisfied with
outpatient/ambulatory medical care services; however, housing was repeatedly indicated as a
service with low consumer satisfaction. When it came to cultural competency, MSM consumers
felt they were treated differently because of status and not because of some other condition. Lack
73
of housing and/or being homeless still remains a barrier of care for PLWHA followed by denial,
low self-esteem, provider location and wait time at agencies. All groups felt confident in being
able to do what they can to prevent transmission. Participants also suggested having more
accessibility to condoms, more HIV testing advertisement and putting sex education back in the
school would be most helpful in addressing HIV prevention.
RESOURCE INVENTORY
As provided in Appendix, the resource inventory describes organizations providing services
accessible to PLWHA. It includes information related to the type and description of services as
well as eligibility and contact information. The identification of resource center locations and the
services provided therein allows agencies to share accurate information with PLWHAs. This
information also allows those that can assist with the expansion of services to see where gaps in
service opportunities exist and how they can possibly be filled by neighboring resources.
Overall, the collection and centralization of resources can create more collaboration among the
various resource centers.
Method. Secondary data sources were used to compile the comprehensive list of available
community resources. Service providers were categorized by specialty. Provider services
coordinators, members of the grantee staff, telephoned service providers to verify contact
information and current services offered. If the service provider was unreachable by phone, the
provider services coordinators referred to the organization's website (if available) for necessary
information to include in the list of resources in addition to seeking community expertise.
Findings. The resources in the Memphis TGA are comprehensive and are inclusive for the eight
county area in Tennessee, Mississippi and Arkansas. Services include medical providers (n=13
providers); alcohol/drug residential programs (n=13); church sponsored support (n=23 faithbased organizations); housing services (n=17 providers); transportation services (n=12); and
legal services (n=6). HIV testing sites funded by the CDC HIV Prevention and Expanded Testing
grants were added to the database (n=30). An updated list of the Memphis TGA Service
Providers for fiscal year 2015 may be found in Appendix?.
Summary. The resource inventory is extensive and provides information, organized by category
or type of service, about resources that are most often needed by PLWHA..
74
PROVIDER CAPACITY AND CAPABILITIES
1.
Provider Survey
Method
A survey was constructed and every provider who was paid using Ryan White Part A funding
was asked to complete the survey. The surveys were developed with collaboration of various
provider and consumer committees in the TGA and was pretested with Ryan White Staff and
providers. Over eighty invitations were extended, and forty four complete surveys were
recorded. Collection of responses ran from 4/7/2015 through 4/23/2015.
Analysis
The survey data was analyzed using Microsoft Excel and the built -in functions
statistical functions of the website Survey Monkey.
Provider representation
Over one-third of the responses came from the largest funded provider, Adult Special Care
Clinic.
Table 9-1. Provider Survey Response in the Memphis TGA
Provider
Response Percent
Adult Special Care Clinic
38.6%
11.4%
Friends for Life
11.4%
Mobile Ministry of Dentistry
9.1%
6.8%
Le Bonheur
4.5%
Memphis Health Center
4.5%
2.3%
Hope House
2.3%
Resurrection Health
2.3%
2.3%
The Church On The Square
2.3%
UT Medical Group Inc.
2.3%
Cocaine and Alcohol Awareness Program, Inc.
0.0%
Crisis Center
0.0%
Community Services Agency
0.0%
Memphis Gay and Lesbian Community Center
0.0%
St Jude
0.0%
Source: Survey Monkey, 2015 Provider Needs Assessment
75
Roles of respondents at provider
All funded providers were surveyed, with the largest portion of respondents being represented by
the “Other” and Medical Case Manager categories.
Table 9-2. Provider Role Completing Survey
Role
Response
Percent
36.4%
Other
31.8%
Medical Case Manager
11.4%
Early Intervention Specialist
9.1%
Physician
4.5%
Non-Medical Case Manager
4.5%
Nurse
2.3%
Social Worker
Services provided
To get a grasp on what
Table 9-3. Core Medical Services rendered by the
respondent’s organizationCore Medical Services
Response Percent
Medical case management, including treatment
adherence services
Medical care (Outpatient and ambulatory medical
care)
AIDS pharmaceutical assistance
AIDS drug assistance program
Health insurance premium and cost-sharing assistance
for low-income individuals
Oral health
Home and community-based health services
Substance abuse outpatient care
Hospice services
Home health care
72.7%
65.9%
63.6%
56.8%
52.3%
52.3%
47.7%
43.2%
40.9%
20.5%
15.9%
2.3%
0.0%
76
Table 9-4. Supportive Services rendered by the respondent’s organization
Supportive Services
Response Percent
Referral for health care/supportive services
Treatment adherence counseling
Outreach services
Food bank/home-delivered meals
Housing services
Linguistics services (interpretation and translation)
Substance abuse services—residential
Legal services
Child care services
Respite care
65.9%
65.9%
56.8%
56.8%
52.3%
47.7%
40.9%
38.6%
38.6%
34.1%
27.3%
6.8%
4.5%
2.3%
0.0%
0.0%
Demographics of Providers
The providers are generally non-Hispanic Black/African American cis-gender females aged 2544 years. No one surveyed identified as transgender, transsexual, or gender non-conforming. No
one identified as Hispanic or Asian. As compared to the PLWHA in Memphis TGA (Figure 2-5),
both are mostly non-Hispanic Black/African American of roughly the same age bracket.
However, the largest portion of PLWHA are MSM (Table 2-5), compared to the 81.8% (Table 96) straight-identifying providers. Also, 72% of our PLWHA are male (Table 2-5) while only
15.9% (Table 9-7) of our providers are male.
Table 9-5. Age Range of Respondents
Age Range
25-44
45-64
13-24
65 or older
Response Percent
61.4%
29.5%
4.5%
4.5%
77
Table 9-6. Sexual Orientation of Respondents
Sexual Orientation
Response Percent
81.8%
Straight
11.4%
Gay or lesbian
6.8%
I don't identify as any of these.
0.0%
Bisexual
Table 9-7. Sex at Birth of Respondents
Sex at birth
Female
Male
Response Percent
84.1%
15.9%
Table 9-8. Race of Respondents
Self-identified race
Response Percent
65.9%
Black/African American
29.5%
White/Caucasian
4.5%
Other
2.3%
Native Hawaiian or Pacific Islander
0.0%
Asian
0.0%
American Indian or Alaskan Native
Length of Service
The largest portion of the providers surveyed has provided service to PLWHA for six or more
years. Over 70% of the providers surveyed have provided care to PLWHA for three years or
over.
Table 9-9. Time rendering care to PLWHA
Provision of care to PLWHA
Response Percent
6 or more years
3-4 years
Less than 6 months
5-6 years
6-12 months
2-3 years
4-5 years
1-2 years
Less than 1 month
38.6%
15.9%
11.4%
9.1%
6.8%
6.8%
6.8%
4.5%
0.0%
78
Programming Assessment
Providers felt that we least adequately addressed the needs of homeless and formerly
incarcerated PLWHA, combined accounting for over 50% of the “no” responses. When we look
at combined “no” and “not sure” responses, over half of respondents were concerned with
undocumented/Spanish-speaking and homeless PLWHA.
Table 9-10. Programming Assessment
Ryan White Programming
Yes
No
Not Sure
No OR Not
Adequacy for this target
Sure
population
90.9%
2.3%
6.8%
9.1%
African Americans
61.4%
6.8%
31.8%
38.6%
Latinos/Hispanics
81.8%
6.8%
11.4%
18.2%
MSM (Men who have sex
with men)
79.1%
2.3%
18.6%
20.9%
Women of childbearing age
55.8%
9.3%
34.9%
44.2%
Youth
58.1%
20.9%
20.9%
41.9%
Formerly incarcerated
individuals
56.8%
18.2%
25.0%
43.2%
People with substance abuse
treatment needs
79.5%
9.1%
11.4%
20.5%
People with need for
dental/oral health services
38.6%
15.9%
45.5%
61.4%
Undocumented immigrants
& Spanish-speaking clients
61.4%
15.9%
22.7%
38.6%
Transgender
47.7%
36.4%
15.9%
52.3%
Homeless
65.1%
14.0%
20.9%
34.9%
Seniors/Elderly
Self-evaluation of Efficacy
Two stepping stones on the path to viral suppression are linkage and retention in care. Providers
had two sections of their surveys where they gave feedback regarding their strategies.
Linkage
Providers were asked to reflect on what methods they feel their organization uses that most
effectively link consumers to care. Almost two-thirds identified their outreach strategies as
primarily responsible for getting consumers linked to care with their respective organizations.
Over a third identified communication and interest as factors in establishing the initial
relationship with the consumers. Interestingly, social media strategies accounted for only a small
amount over 10% of responses.
Table 9-11. Linkage method efficacy
Method
Outreach strategies
Response Percent
63.6%
79
High level of communication with consumers
High level of interest staff take in consumers'
lives and care
Cultural competence
High level of medical care
Social network testing
Social media strategies
Other
40.9%
38.6%
36.4%
36.4%
25.0%
11.4%
2.3%
Retention
Providers were asked to reflect on what methods they feel their organization uses that most
effectively retain consumers in care. Almost 80% of respondents identified the soft skill of
maintaining a caring relationship with consumers as their most effective method of retention.
More than half of respondents felt that their organization’s high level of communication with
consumers, quality of medical care, or staff interest with consumers’ lives and care were directly
responsible for the retention of the consumers in care.
Table 9-12. Retention Method Efficacy
Method
Response Percent
Caring relationship
High level of interest staff take in consumers'
lives and care
Outreach strategies
Cultural competence
Other
79.5%
59.1%
56.8%
54.5%
40.9%
36.4%
4.5%
4.5%
Cultural Competency
Providers felt that the consumers who are least understood and respected by them are those
consumers who speak languages other than English and who have non-HIV illnesses (including
mental illnesses.) When looking at combined “disagree” and “neither agree nor disagree,” we
again find that providers were least confident in their ability to address needs of respect and
understanding consumers who speak languages other than English. About one-tenth of
respondents were unsure or disagreed that their organization adequately respects or understand
eight different aspects of cultural competency when it comes to their consumers.
80
Table 9-13. Cultural Competency Self-Reflection
“I feel, as a provider, that we respect
and understand consumers in regards
to...”
Agree
Neither agree nor
disagree
Their language, if it's not English
63.6%
27.3%
Neither
agree
nor
disagree
OR
Disagree
9.1%
36.4%
The amount of money they have
86.4%
11.4%
2.3%
13.6%
Other illnesses, including mental
illnesses, that they have
The type of job they have
86.4%
6.8%
6.8%
13.6%
88.6%
9.1%
2.3%
11.4%
The type of place they live in
88.6%
9.1%
2.3%
11.4%
Their educational level
The people they are attracted to and
have sex with
The community they're from
Their religious beliefs or lack of
religious beliefs
The gender they express
Who they live with
The appropriate way to address them
and talk to them
Age
Their HIV status
88.6%
88.6%
9.1%
11.4%
2.3%
0.0%
11.4%
11.4%
88.6%
88.6%
11.4%
11.4%
0.0%
0.0%
11.4%
11.4%
90.7%
90.7%
90.9%
9.3%
7.0%
9.1%
0.0%
2.3%
0.0%
9.3%
9.3%
9.1%
95.3%
95.3%
4.7%
4.7%
0.0%
0.0%
4.7%
4.7%
0.0%
4.5%
Race
Disagree
95.5%
4.5%
Contrast with consumers
A mirroring question was asked of consumers, as previously referenced. Interestingly, consumers
and providers agreed on roughly the same things. Consumers were not very critical about
provider’s cultural competency, with the highest “disagree” category at 4.08% of respondents.
Nevertheless, when examining aspects of cultural competency of consumers and providers, both
groups felt that consumers who have other illnesses (including mental illnesses) did not feel
understood and respected about their other illnesses. There was a marked contrast between
providers and consumers in regards to their ability appropriately respect and understand:


Consumers with non-English languages (9.1% vs 0.72%, providers disagreed more)
The consumer’s community (0% vs. 3.13%, consumers disagreed more.)
81
Providers’ needs
Providers felt that transportation was their most important need to be able to get consumers
needed services, mirroring the consumers’ responses to barriers questions. Almost half of
providers felt that wait time was a barrier for consumers, contrasting with 6.13% of consumers
feeling that wait times were unreasonable in Ryan White’s most recent consumer satisfaction
survey. It is interesting to note that between 38.6%-45.5% of the other responses center around
provider education and training.
Table 9-14. Providers’ thoughts on consumer needs
Consumer need
Response Percent
54.5%
Transportation
47.7%
Less wait time for clients during visits
45.5%
Training on how to better advocate for clients/patients
45.5%
Training to provide more efficient services
40.9%
Additional opportunities to share information between
providers
38.6%
HIV care related training surrounding antiretroviral
therapy, managing opportunistic infections, or
monitoring/explaining a patient’s health status
36.4%
Training to enhance cultural competency
29.5%
Faster appointment scheduling
15.9%
Weekend hours
11.4%
Evening hours
4.5%
Other
Provider perspectives on ways to improve services for all
When asked about the one thing that would be most impactful for services to all consumers,
again providers identified training as their main need. If combined with retention strategies, the
second highest response, we find that fully half of the providers feel that further education and
training would have the furthest-reaching effect of improved services for all.
Table 9-15. Improvement suggestions
Answer Options
Training about resources available to help PLHWA in
this area
More effective strategies to retain consumers in care
Response Percent
27%
23%
More education for consumers on managing their illness
18%
Better ways to get consumers to care
More current education for providers on treating HIV
11%
7%
82
More provider locations
A better understanding of the people my organization
serves
Other
7%
5%
2%
Barriers to care
Providers again identified transportation as the main barrier to consumers successfully receiving
care. Equal portions of providers thought that they had too many consumers to adequately
service them with current staffing levels and that consumers simply did not care about their
treatment for HIV.
Table 9-16 Barriers to Care
Answer Options
Response Percent
22.7%
We lack ways to get consumers to care (transportation)
15.9%
Too many consumers for the staff we have
15.9%
Consumers don't care about their HIV treatment
13.6%
Few effective strategies to retain consumers in care
13.6%
Little education for consumers on managing their illness
11.4%
Other
2.3%
A lack of a good understanding of the people my
organization serves
2.3%
Inconvenient hours or inaccessible provider locations
2.3%
Staff doesn't know about resources available for PLWHA in
this area
0.0%
Providers don't seem current on HIV treatment
Prevention
We discovered that our core and supportive services providers have a gap in knowledge of the
prevention programs in our TGA. If we combine the categories of “I've heard about it, but never
referred” and “Never heard about it,” we discover that 53.5%-88.4% of providers have never
utilized the prevention programs. Again, these percentages point to a need of the providers’
simply knowing what is available in the TGA.
83
Table 9-17. Assessment of Provider Knowledge of Prevention Programs
Answer Options
ARTAS
SMILE program
Social Networking Strategies
CLEAR
freecondomsmemphis.org
3MV
TWISTA
Know all
about it; I
refer
regularly
I know
about it
some; I
have
referred
some
13.6%
13.6%
18.6%
6.8%
18.6%
11.6%
4.7%
9.1%
13.6%
14.0%
6.8%
23.3%
2.3%
2.3%
Don't
I've
know
heard
much
about
about
it, but
it; I've
never
referred referred
at least
once
4.5%
31.8%
0.0%
36.4%
4.7%
39.5%
6.8%
34.1%
4.7%
37.2%
2.3%
32.6%
4.7%
32.6%
Never heard
about it
40.9%
36.4%
23.3%
45.5%
16.3%
51.2%
55.8%
84
ESTIMATION AND ASSESSMENT OF UNMET NEEDS
6. Unmet Need Estimate and Assessment
Process for Updating Unmet Need
In the Memphis TGA, there are a significant number of individuals who are aware of their HIVpositive status but are not receiving HIV-related primary health care. Unmet Need for HIV
primary medical care in the Memphis TGA is defined as no evidence of any of the following
three components during calendar year in 2014:
1. Viral load testing;
2. or CD4 count;
3. or Provision of antiretroviral therapy (ARV).
The Epidemiology Section at the Shelby County Health Department was consulted to collect and
analyze data for the unmet need framework, which includes data sources containing the three
components listed above to describe the percentage of PLWHA who are not receiving HIV
primary medical care. Tennessee Department of Health policy requires laboratories to report all
tests indicative of HIV infection, but this regulation did not specifically mandate reporting of
CD4 and viral load labs until 2012. Mississippi and Arkansas legislation does not mandate
reporting of CD4 and viral load tests, but any reported labs are documented. Among the Part A
Ryan White client population, all CD4 and viral load labs are documented in CAREWare, the
electronic medical record system maintained by the Memphis TGA Program. In addition, all
persons receiving services from the AIDS Drug Assistance Program (ADAP) or the Insurance
Assistance Program (IAP) are included in the framework. These data sources are matched using
identifiable information (last name, first name, date of birth) with the state surveillance registry
to classify individuals as “in care” or “out of care.”
Additionally, persons receiving care through state Medicaid may not be included in the
framework data sources listed above. To account for this, the total number of PLWHA
submitting pharmacy claims for antiretroviral therapy to Arkansas, Mississippi and Tennessee
Medicaid programs are subtracted from the framework. Since identifiable data was not available
to directly match to the state surveillance registry, this method likely contributes to duplication
and possibly over-estimates the number of persons in care.
In addition to the limitation described above, it is important to note an additional limitation with
the unmet need framework methodology in the Memphis TGA. Data sources used for some of
the variables in the unmet need framework may not include persons covered outside of the Ryan
White or Medicaid systems of care. Viral loads and CD4 counts for all patients are reportable,
however.
Unmet Need in 2011 - 2014
Disease status for PLWHA enrolled in Tennessee, Mississippi and Arkansas Medicaid programs
is not available, so a stratified breakdown in the total percentage of persons with HIV disease
85
(not AIDS) or AIDS who are out-of-care is only available for data collected from other sources.
As shown in Figure 10-1, among the 7,297 PLWHA in the Memphis TGA, it is estimated that
32% of all PLWHA did not receive primary medical care in the Memphis TGA in 2014. The
Unmet Need percentages in the West Tennessee three counties were the lowest (21% - 29%) and
followed by Crittenden County (56%) among the eight counties in the Memphis TGA. Among
the PLWHA in the North Mississippi four counties, 72%-80% of PLWHA were estimated to be
out of medical care in 2014. Overall we estimate 27% of PLWHA were out of medical care and
73% of those resided in Shelby County, TN (Figure 10-1). Although DeSoto County is
accounted for 5% PLWHA in Memphis TGA, the proportion of Unmet Need is 14% among the
persons out of medical care in 2014 (Table 10-1). This out of proportion between the PLWHA
and Unmet Need by county is most likely due to the lack of outpatient medical provider in north
Mississippi four Counties.
Figure 10-1. Unmet Need among the PLWHA in the Memphis TGA, in 2014
Data Source: Tennessee Department of Health, Mississippi State Department of Health, Arkansas Department of
Health; (eHARS, ADAP/IAP); Ryan White Memphis TGA Part A Program (CAREWare);
86
Table 10-1. Residency of PLWHA out of Medical Care by county, Memphis TGA, 2014
Memphis TGA
Total TN
Shelby,
Fayette, TN
Tipton, TN
Crittenden,
ARMS
Tate,
Marshall, MS
Tunica, MS
DeSoto, MS
PLWHA
N
Residence
7,297
100%
(%)
6296
86%
67
1%
95
1%
246
3%
36
<1%
84
1%
76
1%
397
5%
N
2,336
1694
13
28
137
26
62
57
319
Unmet Need
Unmet Need (%) Residence (%)
32%
100%
27%
73%
21%
1%
29%
1%
6%
56%
1%
72%
3%
74%
2%
75%
14%
80%
Data Source: Tennessee Department of Health, Mississippi State Department of Health, Arkansas Department of
Health; (eHARS, ADAP/IAP); Ryan White Memphis TGA Part A Program (CAREWare)
The Unmet Need Framework is used by the Planning Council to prioritize and allocate funding
for services. This data is presented to the Planning Council during the Priority Setting and
Resource Allocation process. In addition, the Grantee provides monthly updates to the Planning
Council with service utilization and client survey data. The Grantee and the Planning Council
consider all the available data from these reports in prioritizing and allocating funding for
services, and in developing the system of care. As outlined in Table 10-2, of those 7,279
PLWHA, 68% (n=4,961) individuals received specified HIV primary medical care during the 12
– month of period in 2014 in Memphis TGA. However, during the same time period total
number of 2,336 (32%) persons living with diagnosed HIV infection did not have any evidence
of receiving any types of medical care.
Table 10-2. Unmet Need Framework in the Memphis TGA, in 2014
Input
Row
A.
Row
B.
Row
C.
Row
D.
Population Sizes
Number of persons living with AIDS
(PLWA), for the period as of
12/31/2014
Number of persons living with HIV
(PLWH)/non-AIDS/aware, for the
period as of 12/31/2014
Total number of HIV+/aware for the
period as of 12/31/2014
Care Patterns
Total number of HIV+/aware who
received the specified HIV primary
medical care during the 12-month
period [1/1 /2014 – 12/31/2014]
Value Percent
(%)
3,576
3,721
7,297
Value
4,961
68%
Data Source(s)
TN Enhanced HIV/AIDS
Reporting System
(eHARS)
Reporting System
(eHARS)
Reporting System
(eHARS)
Data Source(s)
Reporting System
(eHARS), Ryan White
Care Ware, HDAP, IAP
Database
87
Row
E.
Calculated Results
Total HIV+/aware not receiving the
specified HIV primary medical care
(quantified estimate of unmet need)
Value
2,336
32%
Calculation
Percent: E/C
(1) Shelby County Health Dep artment,Epidemiology Section, 814 Jefferson Ave. Memphis TN,
38104.
(2) Mississippi Department of Health, S TD/HIV Office. P.O. Box 1700 Jackson, MS 39215.
(3) Arkansas Department of Health, HIV/AIDS Registry Section . 4815 W. Markham, Little Rock
AR 77205. The HIV/AIDS Registry Section is fully funded by a Cooperative Agreement with
the Centers for Disease Control a nd Prevention (CDC).
Trends associated with Unmet Need data
The West Tennessee three counties (Shelby, Fayette, and Tipton) account for 88% of the total
PLWHA in Memphis TGA in 2014. Due to the limitations of availability and reliability of data
from the north Mississippi four counties and Crittenden County in Arkansas, the trends of Unmet
Need are analyzed with the data from the West Tennessee three counties. The Unmet need
assessments in the Memphis TGA began in calendar year 2007, which was included in the first
Memphis TGA FY2009 grant. The Unmet Need percentage among the PLWHA in the west TN
has steadily and continually decreased 55% between 2009 and 2014. This decline is reflected in
both the Persons Living with AIDS (PLWA) and Persons Living with HIV not AIDS (PLWH)
from 70% and 48% in 2009 to 37% and 16%; and higher number of PLWA (84%) received
medical care compare to the PLWH (63%) in 2014 (Figure 10-2). This is likely attributable to
the Ryan White Part A medical and supportive services implemented over the past six years. In
addition, the policy change to include mandatory reporting of all CD4 and Viral Load tests in the
state of Tennessee provided additional data sources to improve estimates of unmet need
beginning in 2012.
Figure 10-2. Unmet Need among the PLWHA, West TN three Counties, 2009 – 2014
Data Source: Tennessee Department of Health; (eHARS, ADAP/IAP); Ryan White Memphis TGA Part A Program
(CAREWare);
88
While efforts have been made to increase linkage and outreach services, the number of PLWHA
out of medical care are significantly decreasing. This inverse correlation between linkage to care
and Unmet Need among the PLWHA in the West TN shows the Unmet Need decrease results
from the linkage to care increase; highlights the importance of interviewing and referring clients
for partner and prevention services (Figure 10-3).
Figure 10-3. Linkage to Care and Unmet Need in the West Tennessee, 2007-2014
Data Source: Tennessee Department of Health; (eHARS, ADAP/IAP); Ryan White Memphis TGA Part A Program
(CAREWare);
With the continual increase of Linkage to Care from 51% in 2009 to 66% in 2014, the percentage
of Unmet Need decreased from 60% in 2009 to 26.9% in 2014. As a result of this decrease of
Unmet Need, HIV incidence rate decreased approximately 14% from 28.3 to 24.4 (per 100,000
persons) in Memphis TGA (Table 2-6). In addition, AIDS incidence rate increased in 2013 and
2014 (Table 2-8). The Increase of linkage to care and reduction of Unmet Need are the be
testament to successful prevention and care measures.
Demographics and Location of PLWHA Not In Care
The Unmet Need trends of PLWHA between 2011 and 2012 in Shelby county TN are reflected
on the zip code level geographic map shown in the Map 4-1 to Map 4-4. The zip code level map
of Unmet Need was created based on the number of persons out of medical care among the
PLWHA in Shelby County using ArcGIS 10.2. The data for the 2011 Unmet Need map
classified by quantiles, and this quantile measurement is used for the 2012 to 2014 Unmet Need
map in order to show the trend of the Unmet Need by Zip Code level. The darkest shaded area
represents the highest concentration of the individuals out of medical care.
Figure 4-2 shows that while the Unmet Need equals 40%, five zip code areas (38103 – 38105,
38106 – 38126) represented Unmet Need highest concentrated areas (more than 198 persons /zip
code) and six zip code areas (38107-38108, 38112-38122, 38109, 38116, and 38115) represented
Unmet Need second highest concentrated areas (132-198 persons/zip code) in 2011 in Shelby
89
county. In 2014, the Unmet Need decreased to 27% and the five darkest shaded areas (198+
persons/zip code) that were shown in 2011 disappeared and reduced to Unmet Need second
highest concentrated areas; the second highest concentrated areas changed to Unmet Need lesser
concentrated areas (67 – 132 persons/zip code). The zip code level Unmet Need map also shows
the correlation between the area of higher percentage of Unmet and the area of higher rates of
HIV incidence and prevalence (Map 2-4).
PLWHA Underrepresented in the Memphis TGA Ryan White HIV/AIDS System of Care
Demographics such as sex, race, and age were analyzed among persons with unmet need (Table
10-3). Eighty-five percent of those not receiving primary medical care were Non-Hispanic
Blacks, followed by 11% Non-Hispanic Whites, and 4% of Hispanics in Shelby County TN in
2014. The majority (70%) of persons identified as out of care were male. Persons aged 25-44
accounted for 48% of persons not receiving primary medical care, followed by persons aged 4564 years (47%). The reported transmission risk categories for those not in care were MSM
(36%), heterosexual activity (29%); and 28% of the out-of-care individuals have unidentified
risk. Among the Non-Hispanic Blacks males, 20-44 year old age group accounts for 55%, and
MSM accounts for 49% of those out of medical care; Among the Non-Hispanic Black females,
the child bearing age group (20-44 year old) accounts for 56%, and Heterosexual contact
accounts for 64% of those Non-Hispanic Black females out of medical care, respectively.
Table 10-3. Number of cases and percentages among the PLWHA out of Medical Care by
Demographic Characteristics, West Tennessee three Counties, 2014
Total
Total
Gender
Male
Female
Race/Ethnicity
White, Not
Hispanic
Black, Not Hispanic
Hispanic, All Races
Other, Not
Hispanic
Current
Age as of
2014
0 to 19
20 to 24
25 to 34
35 to 44
45 to 54
55+
Risk/Exposure
Male Sex with Male
Heterosexual
Contact
MSM/IDU
IDU
Black Male
N
%
1,010
58%
Black Female
N
%
26%
457
1,010
NA
100%
NA
NA
457
NA
100%
N
1,735
%
100%
1,220
515
70%
30%
188
1,467
65
15
11%
85%
4%
1%
26
73
364
462
489
321
1%
4%
21%
27%
28%
19%
15
59
238
249
268
181
1%
6%
24%
25%
27%
18%
8
10
91
154
128
66
2%
2%
20%
34%
28%
14%
621
500
31
75
36%
29%
2%
4%
495
153
18
36
49%
15%
2%
4%
NA
293
NA
16
NA
64%
NA
4%
90
Perinatal Exposure
blood transfusion
No Identified
22
4
482
1%
<1%
28%
10
1
297
1%
<1%
29%
10
NA
138
2%
NA
30%
Data Sources: TN Enhanced HIV/AIDS Reporting System (eHARS), Ryan White Care Ware, HDAP, IAP Database.
Sources: TN Enhanced HIV/AIDS Reporting System (eHARS), Ryan White CAREWare, HDAP, IAP Database.
91
92
Early Identification of Individuals with HIV/AIDS (EIIHA)
Ryan White HIV/AIDS Program Part A included EIIHA strategy for the identifying, counseling,
testing, informing, and referring of diagnosed and undiagnosed individuals to appropriate
services, as well as linking newly diagnosed HIV positive individuals to medical care in the
Memphis TGA. The goals of this initiative are to increase: 1) the number of individuals who are
aware of their HIV status, 2) the number of HIV positive individuals who are in medical care,
and 3) the number of HIV negative individuals referred to services that contribute to keeping
them HIV negative. This outreach services include services to both HIV infected persons who
know their status and are not in care and HIV-infected persons who are unaware of their status
and are not in care.
HIV Testing
Examining data about HIV testing can help identify potential gaps in surveillance systems, which
only represent persons who have been tested for HIV. The EIIHA data for Crittenden County in
Arkansas and Marshall, Tate, Tunica, and DeSoto counties in Mississippi were not available by
demographic characteristics during the development of this application. Each health department
has separate systems for capturing data, as well as ways of separating the data that do not
necessarily match the boundaries of the TGA. The program is continuing to work with the
Arkansas and Mississippi Departments of Health to design systems to capture necessary
information for the counties within the Memphis TGA. A negative HIV test result is not a
reportable event in Tennessee; thus, routinely collected HIV testing utilization data is only
available from sites funded by the Tennessee Counseling and Testing Programs.
93
As outlined in Table 10-4, a total of 34,707 tests were conducted and 514 HIV infected persons
(including previously identified HIV infected) were identified with 1.5% test positivity among
the expanded HIV testing sites in Memphis TGA in 2014. Of the total tests, the majority of tests
30,383 (87.5%) were administrated in the West Tennessee three counties, and 88.7% (n=456) of
HIV positive individuals identified. The high percentage of HIV test positivity data recommends
Memphis TGA to increase the number of tests and testing sites in all those eight counties to
identify more individuals unaware of their HIV+ status.
Table 10-4. HIV tests conducted by counties in the Memphis TGA, 2014*
# of HIV Test Conducted
# of Positive Tests
Test Positivity
West TN three Counties
34,707
30,383 (87.5%)
514
456 (88.7%)
1.5%
1.5%
North MS four Counties
2,989 (8.6%)
45 (8.8%)
1.5%
Crittenden, AR
1,335 (3.8%)
13 (2.5%)
1.0%
Total
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; Tennessee Department of Health; Arkansas
Department of Health; Mississippi Department of Health. *preliminary data subject to change
Figure 10-4 shows the positive correlation between the number of tests conducted and the
number of newly diagnosed HIV cases in the Memphis TGA 2010 - 2014. During this five year
period, the highest number of tests (n=49,374) and the highest number of new HIV individuals
(n=429) were identified in 2012. With reduction of number of HIV tests since 2012, newly
identified HIV infected individuals have decreased from 429 cases in 2012 to 324 cases in 2014.
This decrease was partly due to the decrement of the number of HIV tests conducted from
49,374 to 34,707 in the Memphis TGA.
Figure 10-4. Number of Tests and New HIV Diagnosis, Memphis TGA, 2010 – 2014
Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; Tennessee Department of Health; Arkansas
Department of Health; Mississippi Department of Health. *preliminary data, subject to change
94
Testing at Publicly Funded Counseling and Testing Sites in Shelby County
Twelve HIV testing sites were funded by the Tennessee Counseling and Testing Program in
Shelby County during 2014. These sites include the local health department sites, emergency
department sites, community-based organizations (CBOs), Care and Prevention in the United
States (CAPUS) funded organizations, and public clinics.
In 2014, total 29,311 tests were conducted in Shelby County; 451 tests were positive with 1.5%
positivity, and 279 new HIV cases were diagnosed (Table 10-5). Among the publicly funded test
sites, the health department sites administered the highest number of tests (n=14,028) and
reported the highest percentage of positivity (2.9%).
Table 10-5. HIV Tests at Publicly Funded Test Sites in Shelby County, 2014
Test Sites
Health Department
Friends For Life/CAPUS
LeBonheur Children’s
Hospital
PEAS
Planned Parenthood
Walgreens
Total, All sites
Number of Tests
14,028
925
12,774
247
1,140
197
29,311
Number positive
401
15
32
2
0
1
451
Positivity (%)
2.9%
1.6%
0.3%
0.8%
0.0%
0.5%
1.5%
Sources: Patient Tracking Billing Management Information System (PTBMIS), TN department of Health, Care and
Prevention in the United States (CAPUS)
Of the 14,028 tests conducted at the health department sites, the proportion of males were 56%,
not-Hispanic Blacks were 82%, and 67% tests were conducted among the age group 15-34 years
old (Table 10-6). Publicly funded HIV test sites aim to target the most at-risk populations; thus,
demographic characteristics of those tested in publicly funded sites will not match that of the
Memphis TGA population.
Table 10-6. HIV Tests Conducted by demographic characteristics,
Shelby County Health Department, 2014
Total
Gender
Male
Female
Race/Ethnicity
Black, Not Hispanic
Hispanic, All Races
Other, Not Hispanic
White, Not Hispanic
Age Group (at tested)
0-14 years
15-19
Number (N)
14,028
Percent (%)
Positive (N)
Positivity (%)
7,960
6,068
56%
43%
250
151
3.1%
2.5%
11,657
284
187
1,900
82%
2%
1%
13%
362
5
3
31
3.1%
1.8%
1.6%
1.6%
141
1,488
1%
10%
0
14
0.0%
0.9%
95
20-24
25-34
35-44
45-54
55+
3,197
4,869
2,309
1,384
640
23%
34%
16%
10%
5%
77
150
68
65
27
2.4%
3.1%
2.9%
4.7%
4.2%
Data sources: Patient Tracking Billing Management Information System (PTBMIS), TN department of Health, Care
and Prevention in the United States (CAPUS)
Estimated Number of Unaware
The Centers for Disease Control and Prevention (CDC) developed a statistical model, the
“extended back calculation method,” to estimate those unaware of their HIV-positive status. This
model is based on the 2006 Serologic Testing Algorithm for Recent HIV Seroconversion (known
as STARHS) that examines historical trends in HIV infections in the United States from 1977200611. The extended back calculation method can be applied to the Memphis TGA
epidemiologic data; however, the model is based on a national proportion and thus not specific to
the Memphis TGA jurisdiction. CDC estimates that 14 percent of people infected with HIV in
the United States are unaware of their infection. In applying this statistical model to the number
of PLWHA in the Memphis TGA at the end of 2014, we estimate that 1,188 individuals were
HIV-positive but unaware of their status. In other words, 1 in 7 persons infected with HIV
unaware of their HIV status. At the end of 2014, with this calculation method, total persons
living with HIV disease in Memphis TGA including persons unaware of their HIV status are
estimated to be 8,485. This estimate is calculated using the Estimated Back Calculation (EBC)
methodology below:



National Proportion Undiagnosed (14%)=P
Number of individuals diagnosed with HIV and living as of December 31, 2014 =N
P ÷ (P – 1) x N = 14% ÷ (1 – 14%) x 7,297(diagnosed living HIV/AIDS) = 1,188
(unaware)
 Total number of persons living with HIV disease=7,297+1,188=8,485.
In 2014, total 34,707 tests were conducted among sites receiving expanded HIV testing funding
in the Memphis TGA (Table 10-7). Of the total tests, 1.5% (n=514) were positive, and 324 of
those were identified as new HIV infections and 190 of them were previously positive cases. Of
the 324 new infections, 231 cases were successfully linked to medical care.
Table 10-7. Newly diagnosed positive HIV test events, Memphis TGA, in 2014
Number of test events
Number of newly diagnosed positive test events
Test positivity
Number of newly diagnosed positive test events with client linked to HIV
medical care
Number of newly diagnosed confirmed positive test events
Number of previously diagnosed positive test events
34,707
324
1.5%
(514)
231
324
190
Data Source: Enhanced HIV/AIDS Reporting System (eHARS), TN; Tennessee Department of Health; Arkansas
Department of Health; Mississippi Department of Health
96
The continuum of engagement in care for persons living with HIV/AIDS ranges from those who
are unaware of their HIV-positive status to those who are fully engaged in HIV primary medical
care (Figure 10-5). Several different evaluation measures are used to estimate those unaware of
their HIV-positive status, those not receiving primary medical care, and the level of retention
among those who are in-care. According to the CDC recommendation for improving the health
of persons with HIV and reducing the number of new HIV depend on increasing access to HIV
medical care and eliminating disparities in the quality of care received.
In the United States, the challenge of late diagnosis of HIV infection poses obstacles to HIV
prevention efforts, which contributes to the spread of HIV by those who do not know they are
infected10. In the continuum of engagement in care, individuals unaware of their HIV-positive
status are located at the left of the spectrum, as they have not been tested after initial infection, or
they never received their positive test results.
Figure 10-5 The Continuum of Engagement in Care for Persons Living with HIV/AIDS
Continuum Engagement in Care
Not in Care
Unaware of
HIV Status
(not tested or
never
received
results)
Fully Engaged
Aware of
HIV status
(not referred
to care; did
not keep
referral)
May be
receiving
other medical
care but not
HIV care
Entered HIV
primary
medical care
but dropped
out (lost to
follow-up)
In and out of
HIV care or
infrequent
user
Fully
engaged in
HIV primary
medical care
Source: National Quality Center; www.nationalqualitycenter.org
In applying this statistical model to the number of PLWHA in the Memphis TGA at the end of
2014, we estimate that 1,188 (14%) individuals are HIV-positive but unaware of their status.
Measuring the time between initial HIV disease diagnoses and AIDS diagnoses can also provide
insight around those who are unaware of their HIV-positive status. A significant number of
persons do not undergo testing for HIV until they become immunosuppressed. In a study
involving over 4,000 persons diagnosed with AIDS from 16 states, the CDC found that 45% of
these individuals received an initial HIV diagnosis within one year of their AIDS diagnosis.
Given the history of HIV infection, this suggests that many of these individuals were probably
unaware of their HIV positive status 5–10 years before diagnosis.
As depicted in Figure 10-6, the time between initial HIV diagnosis and AIDS diagnosis in the
West Tennessee three counties is described between 2009 and 2014. In 2009, 17% of newly
diagnosed HIV infected cases had an initial AIDS diagnosis within three months of their HIV
infection diagnosis in the 12 – month measurement period. While the HIV diagnosis decrease
from 402 cases in 2009 to 332 cases in 2013, the proportion of the Late HIV Diagnosis increase
from 17% in 2009 to 28% in 2013. The increasing of the Late HIV diagnosis in recent years
implies that there are significant numbers of persons living with HIV unaware of their HIV
positive status in the Memphis TGA.
97
Figure 10-6. Late HIV Diagnosis in Shelby, Fayette, and Tipton
Counties in Tennessee, 2009 – 2014
Source: Enhanced HIV/AIDS Reporting System (eHARS), TN
CONCLUSION
Conclusion of Consumer Needs Assessment Survey
Consumers voiced most clearly in this survey their lack of basic needs such as food, shelter, and
money for utilities. They also indicated mental health and psychosocial needs such as stigma and
acceptance of their HIV status. Once those needs are met, consumers seem to indicate needs for
physical access to services, whether by closer locations to them or via transportation, education
about services available, and assistance with insurance linkage and financial assistance with any
portion of service they may be responsible for. Oral healthcare topped the list of services that
consumers say they need but don’t get; however, many will hit the cap yearly and be unable to
receive needed services.
Conclusion of Provider Needs Assessment Survey
Providers are indicating both needs for themselves and for the consumers they serve to be more
effective. For themselves, the providers are most clearly indicating that they need enhanced
education, training, and opportunities to network with other providers. As with the consumers
they serve, there is a clear need to help providers to recognize what resources and programs are
in the community to help with the people they serve. Additionally, providers viewed their
cultural competency with a more critical eye than did the consumers with several clear aspects of
cultural competency they felt they needed more training to address appropriately. For the
consumers, providers indicate they need to get into contact with the consumers they serve,
typically by the consumers coming to them. This has historically been, and continues to be, a
major barrier according to responses of both consumers and providers.
98
RECOMMENDATIONS
The following are recommendations to improve medical and supportive services for clients:
Consumer Recommendations
Medical Transportation, Housing, and Emergency Financial Assistance services should be
examined and our methods of service delivery compared to other TGAs in an effort to enhance
availability and quality of service. Enhancing availability of service, most easily through medical
transportation solutions, should be considered. Innovative ideas such as using smartphonemanaged point-to-point transportation might be worth considering. Mental health and
psychosocial support services should be bolstered and processes of getting consumers into
mental and psychosocial support should examined for their quality. An educational campaign
may be in order to address the continuing problems of stigma and infection acceptance.
Education of the consumer about resources, services, and locations that are available should be
undertaken as well. Finally, oral health care, being an important part of overall health of the
HIV-infected individual, should be examined closely for utilization and considered for funding
and cap enhancement.
Provider Recommendations
The Memphis TGA Ryan White Part A Program has already set in place programs and services
to begin to address some of the aforementioned needs of providers and consumers. A
transportation committee is currently meeting to address needs that have been so clearly voiced
by both providers and consumers. There are meetings to educate both consumers and providers
on HIV, adherence, and other aspects of the continuum of care. Finally, there are periodic
medical case manager webinars and EIS/DIS meetings to facilitate information sharing and help
all parties better understand the larger picture of the process from identification of infection to
linkage to and retention in care.
The strong response for education and training may suggest development of a living document,
annually updated (at minimum,) providing standardized induction/orientation/reference
curriculum for Ryan White providers. Hosting this on the hivmemphis.org website seems to be
the most natural choice.
Providers should understand not only the illness of the people they serve, but also the larger
picture of the flow of consumers through the structures established by the Ryan White program,
and available core and supportive services. Opportunities should be set up for providers to be
able to share strategies and network with others who provide services to Ryan White consumers.
Provision of more collaborative educational opportunities between providers, particularly in the
areas of resources, including prevention resources; cultural competency, particularly in the area
of non-English speakers; advocacy; and strategies to help consumers manage their illness seems
to be needed as well.
Providers are concerned about the adequacy of programming that Ryan White is providing for
Homeless, Formerly incarcerated individuals, People with substance abuse treatment needs,
Undocumented immigrants & Spanish-speaking clients, Transgender, Seniors/Elderly, and
99
Youth. Those groups should be further examined for needs, in particular the seniors/elderly due
to the aging PLWHA population and transgender consumer, who in the latest consumer
satisfaction survey indicated some of the lowest levels of satisfaction with services provided.
Providers believe that they are able to connect with consumers and bring them into care. Further
education and opportunities to collaborate and share with their fellows will enable providers to
even more effectively address consumer needs. Improvements to services such as transportation
coming out of committees now formed will further enable providers to give high quality care to
our consumers.
100
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101
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19. Continuum of HIV Care: Definitions. at
<http://hab.hrsa.gov/data/reports/continuumofcare/continuumdefinitions.html>
McGowan, T. (2009).
20. The 2009 Memphis TGA Ryan White HIV/AIDS Care Needs Assessment.
21. Pichon, LC, Morrell, K, Digney, SA, Montgomery, M, Asemota, A. (2012). The 2012 Memphis
Transitional Grant Area (TGA) Ryan White Part A Comprehensive Needs Assessment. Memphis,
TN; The University of Memphis School of Public Health, Memphis TGA Ryan White Part A
Program, Shelby County Health Department Epidemiology Section.
102
APPENDIX 1. CONSUMER SURVEY
103
2015 Needs Assessment
Consent
* INFORMED CONSENT
Consumer Participation
2015 Comprehensive Needs Assessment
You are being invited to participate in a comprehensive needs assessment survey for people living with
HIV/AIDS. This study is being conducted by The Ryan White HIV/AIDS Program. By responding to the
survey question, you are assisting the HIV-Care and Prevention Group set funding priorities and plan for
future service needs in the Memphis Transitional Grant Area.
Your consent is entirely voluntary; refusal to participate will not affect the care you are receiving or the
relationships you have with any service providers at any agency. If you choose to participate, you will not
have to answer any questions you do not wish to answer.
All information provided will be kept confidential. Survey results will not be released or reported in any way
that might allow for identification of individual participants, and in no case will responses from individual
participants be identified. No one will be able to determine your association with any service provider.
Your participation in the survey typically takes 10-15 minutes. The questions are for you to share any
thoughts, opinions and attitudes your have relative to gaps in services for your HIV care.
There are no potential risks if you decide to participate in this survey and there are no costs associated with
your participation. However, at the end of this interview, you will receive a $ 10 gift card for your
participation in the survey.
If you have any questions, please contact Nycole Alston, Planning Group Manager, Shelby County
Government, Ryan White Part A Program, (901)222.8283 [email protected].
Consent Statement: I have read or had read to me the preceding information describing this survey. All my
questions have been answered to my satisfaction. I understand that I am free to withdraw from the survey
at any time.
I understand the above information and would like to participate in the needs assessment survey.
I agree
I do not agree
Demographics
This page gathers demographic data about the client taking the survey.
* What county do you live in?
Shelby County, TN
Crittenden County, AR
Desoto County, MS
Fayette County, TN
Marshall County, MS
Tate County, MS
Tipton County, TN
Tunica County, MS
* What is your current living situation?
Stable (for example: I own the home I live in; I rent the home I live in; I rent a room; or I receive HOPWA, TBRA, Section 8
assistance; LONG TERM placement in a psychiatric hospital or other psychiatric facility; foster care home or foster care group
home; or other residence or long-term care facility)
Temporary (for example: I live with friends, family members are letting me stay with them, I'm paying for a hotel or motel out of my
own pocket, or I'm receiving temporary help to afford a place to live, temporary placement in a psychiatric hospital or other
psychiatric facility.)
Unstable (for example: I'm living on the streets, in a car, bus station, abandoned building; or I'm living in a hotel or motel paid for
with an emergency shelter voucher.)
Decline to respond.
* Which of the following age groups are you in?
Under 2
2-12
13-24
25-44
45-64
65 or older
Decline to respond.
* Do you think of yourself as (please check all that apply):
Straight
Gay or lesbian
Bisexual
Decline to respond.
* What sex were you assigned at birth, on your original birth certificate?
Male
Female
Decline to respond.
* How do you describe yourself? (check one)
Decline to respond.
Male
Female
Transgender, transsexual, or gender non-conforming
I do not identify as any of these.
Transgender specification
* Which of these best describes you?
Transgender or transsexual, male to female
Transgender or transsexual, female to male
Gender non-conforming
Decline to respond.
Hispanic Ethnicity
* Are you Hispanic?
Yes
No
Hispanic Ethnicity Specification
Mexican, Mexican American, Chicano/o
Puerto Rican
Cuban
Another Hispanic, Latino/a, or Spanish origin
Race
* What is your race? (check all that apply)
White/Caucasian
Asian
Asian Ethnicity Specification
* If you are Asian, which best describes you?
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiian or Pacific Islander Ethnicity Specification
* If you are Native Hawaiian or Pacific Islander, which best describes you?
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Other Demographics
* What is your current relationship status?
Single
Married
Living with partner
Widowed
Separated
Divorced
Have a steady partner but not living together
Decline to respond.
* As of right now, what best describes your current job situation?
Disability
Retired
Self-employed
Student
Unemployed and looking for work
Unemployed and not looking for work
Working a full-time job
Working off and on
Working a part-time job
Decline to respond.
* What is your highest level of education?
Less than high school
High School Graduate or GED
Some college or vocational school
College Graduate (Bechelor's Degree)
Graduate degree (Master's Degree, Doctorate, MD, PhD)
Decline to respond.
* How long have you been receiving Ryan White funded HIV care, treatment, or other supportive services?
I haven't received Ryan White funded care, treatment, or supportive services for 12 months or longer.
Less than three months
3-6 months
6-12 months
1-2 years
2-4 years
Longer than 4 years
* What made you get tested for HIV? (Check all that apply)
My doctor suggested it.
I had unprotected sex.
I just wanted to know my status.
It was offered to me during a medical visit.
It was for my partner's safety.
I was diagnosed with another STD.
I was inspired by a friend.
I shared needles.
I saw an ad about HIV.
Free tests were offered at an organization I know.
Because a sexual partner tested positive.
I got tested on a regular basis.
Decline to respond.
* Have you ever been diagnosed with HIV?
Yes
No
Don't know
Decline to respond.
* How long ago were you diagnosed with HIV?
1-3 years ago
4-6 years ago
6-10 years ago
Over 10 years ago
Decline to respond.
* Have you ever been diagnosed with AIDS?
Yes
No
I don't know.
Decline to respond.
Other Demographics p2
* How long ago were you diagnosed with AIDS?
1-3 years ago
4-6 years ago
6-10 years ago
Over 10 years ago
Decline to respond.
* How soon after you were diagnosed with HIV did you go to see a doctor about your HIV diagnosis?
Immediately
Within 6 months
Within a year
Longer than 1 year
I have not yet seen a medical provider about my HIV.
Don't remember
Decline to respond.
* Have you had any of the following in the last 12 months? (Check all that apply)
No
Yes
CD4 Counts
Viral Load Tests
HIV medication (ART)
* How often have you received medical care for your HIV infection in the past 12 months?
I have not been to an HIV medical provider in the past 12 months.
This is the first time I've had a visit with an HIV medical provider since I was diagnosed with HIV.
Once (but not first visit since diagnosis)
Twice
Three times
More than three times
Decline to respond.
Core Services Utilization
Don't know
* In the table below, please check one option per category that reflects your needs and awareness of
services for HIV care IN THE PAST 12 MONTHS.
I get service
Medical care (Outpatient
and ambulatory medical
care)
AIDS drug assistance
program
AIDS pharmaceutical
assistance
Oral health
Early intervention
services
Health insurance
premium and costsharing assistance for
low-income individuals
Hospice services
Home and communitybased health services
Substance abuse
outpatient care
Home health care
Medical case
management, including
treatment adherence
services
Support Services Utilization
I need but don't get
service
I need but don't know
about service
* In the table below, please check one option per category that reflects your needs and awareness of support
services for HIV care IN THE PAST 12 MONTHS.
I get service
Case management
(non-medical)
Child care services
Emergency financial
assistance
Food bank/homedelivered meals
Health education/risk
reduction
Housing services
Legal services
Linguistics services
(interpretation and
translation)
Medical transportation
services
Outreach services
Psychosocial support
services
Referral for health
care/supportive services
Respite care
Substance abuse
services—residential
Treatment adherence
counseling
Barriers to service
I need but don't get
service
I need but don't know
about service
* In the past 12 months, which of the following things kept you from getting services you needed?
This doesn't apply to me. I got the services I needed during the past 12 months.
I didn't know where to get services.
I couldn't get an appointment.
I couldn't get transportation.
I couldn't get childcare.
I was too busy taking care of my partner, family, and/or children.
I couldn't pay for services.
I didn't want people to know that I have HIV.
I didn't feel sick.
I don't feel the provider location protects my confidentiality.
I had a bad experience with staff at the provider's office.
I couldn't get time off work.
I was depressed.
I was homeless.
I was afraid of partner abuse or domestic violence.
* The goal of Ryan White providers is that they should understand and respect you as a person, and the
parts of you that make you the unique person who you are, even if those things are very different from the
provider.
Do you agree that you feel understood and respected by Ryan White providers regarding these following
things about you?
I agree
My age
My race
The people I am
attracted to or have sex
with
The gender I express
The amount of money I
have
The type of job I have
Who I live with
The type of place I live in
The community I'm from
My language, if it's not
English
My educational level
address me and talk to
me
My religious beliefs or
My HIV status
Other illnesses,
including mental
illnesses, that I have
I neither agree nor
disagree
I disagree
This doesn't apply to me
* People may miss taking their HIV medicaitons for various reasons. What are reasons why you may have
missed taking your HIV medications? (Check all that apply.)
N/A - I don't take HIV medications.
I didn't miss any doses.
Was away from home
Had a change in daily routine
Simply forgot
Had too many pills to take
Wanted to avoid side effects
Had problem taking pills at specified times
Did not want others to know I was taking HIV medication
Ran out of pills
Felt good/felt healthy
I didn't want to think about HIV
I needed to take pills with food and didn't have food
I didn't pick up medication when it ran out
I didn't have transportation to get my medication
* Thinking back over the last seven days, did you take _______ of your pills?
All
Most
Half
Few
None
N/A (I don't take HIV medications)
Incarceration
* Have you served time in jail or prison since your HIV diagnosis?
Yes
No
Decline to respond.
Incarceration specification
* How long did was the total length of time you were in jail or prison?
Less than one month
1-6 months
6 months-1 year
Over a year
* Did you receive HIV/AIDS related medical care while in jail or prison?
Yes
No
* How long ago were your released from jail or prison?
Currently on house arrest
I'm currently in jail, prison, or in juvenile justice
Less than one month ago
Between one month and six months ago
Between 6 months and one year ago
Between 1-2 years ago
More than 6 years ago
* When you were released from jail/prison, which of the following did you receive? (check all that apply)
Information about finding housing
Referral to medical care
Referral to case management (referral to social worker)
At least a week supply of HIV medication to take with me
This does not apply to me.
* How long did it take you to find stable housing after being released?
Less than 1 month
Between 1 and 6 months
Between 6 months and 1 year
More than 1 year
Still haven't found housing
* How long did it take you to access HIV medical care after being released?
less than 1 month
Between 1 and 6 months
Between 6 months and 1 year
More than 1 year
Still haven't accessed HIV medical care
* What prevented you from getting the HIV/AIDS services you needed after you were released? (check all
that apply)
This does not apply to me. I was able to get HIV services after my release.
No insurance – financial reasons
I did not know where to go
I did not want anyone to know I have HIV
I could not get away from drugs
I was having trouble finding friends I could trust
I did not want to take off from work
I did not have transportation to get services
I did not have ID or documentation to qualify
I had too many other things on my mind
End of survey
* Overall, did you think this survey was:
Too long, but covered all the information
Too long, and I did not want to finish it
Too short, there were more things you could have asked
Just right
Is there anything else you'd like for us to know?
* Would you like to answer two OPTIONAL questions about your feelings regarding preventing the spread of
HIV in the Memphis area?
Yes
No
Optional Questions
What one strategy do you feel would BE MOST EFFECTIVE in preventing the spread of HIV in the
Memphis area? (check one only)
Easier and low or no cost access to healthcare for people infected with HIV
Education in churches about safer sex practices, HIV, and other STDs
More acceptance in the churches of HIV infected individuals
More acceptance in the churches of men who have sex with men (MSM)
More acceptance in the community of HIV infected individuals
More acceptance in the community of men who have sex with men (MSM)
More availability of free condoms
More education of young people about safer sex practices, HIV, and other STDs
More places and opportunities for people to get regularly tested for HIV for free
Widespread, free or low cost availability of medication that helps prevent HIV infection (PrEP)
APPENDIX 2: FOCUS GROUP QUESTIONS
Main Questions
Prompts and/or Probes
GENERAL QUESTIONS
1. Let’s go around the table, introduce ourselves
and share one thing that makes you unique
compared to other people.
COMMUNITY EDUCATION QUESTIONS
2. What are the most important issues faced by
What are the most important needs?
(youth, MSM, North MS residents) living with
What about the needs of a newly diagnosed
HIV?
individual?
3. What behaviors do you think put one at risk for
HIV transmission? Of those behaviors, which
are the biggest problems in your community?
SERVICES QUESTIONS
4. What are the most important HIV-related
services you are using now or have used in the
past year?
5. What services are you most satisfied with?
6. What services are you least satisfied with?
How well do Ryan White Part services meet your
needs?
Does satisfaction include medical care, case
management, transportation, mental health,
substance abuse counseling, support groups?
Does dissatisfaction sometimes have to do with
an experience of stigma and/or providers
(consciously or not) making you feel stigmatized?
7. If you could change one thing in the
HIV/AIDS system of care what would it be?
CULTURAL COMPENTENCY QUESTIONS
8. In your experiences with seeking and using
HIV-related services in the Memphis TGA, do
you feel like you are treated differently
because of some aspect of yourself?
9. Have there been instances when you have felt
particularly welcome, comfortable or
motivated by an agency?
10. Are there instances when you have felt
particularly unwelcome, uncomfortable, or
discriminated against by an agency?
Being a member or being seen as a member of a
particular group
Did you ever tell anyone at the agency about your
experience?
124
11. What topics you would like your provider to
cover with regards to your sex life that they
have not?
BARRIERS TO CARE QUESTIONS
12. What are some reasons why newly diagnosed
individuals do not seek medical care?
13. Are there any barriers that you have
experienced while trying to access services in
your community?
14. What suggestions do you have for making it
easier for people to get the services they need
and stay in care?
15. Are there any services you need but can’t get
or aren’t offered in your area?
PREVENTION QUESTIONS
16. What do you think about HIV prevention
and/or education services offered in your
community?
17. Do you feel confident in being able to do what
you can to prevent transmission to a sex
partner?
18. Describe the ideal HIV prevention program for
(youth, MSM, North MS residents) in your
community?
19. That’s all I have to ask. Are there other things
that you would like to add?
Tell us more about what caused you to be out of
care.
What caused you to stop accessing care?
What could have kept you in care?
Tell us more about how you got back into care.
What made you want to access care again?
If you could change one thing in the HIV/AIDS
system of care what would it be?
Barriers in applying for assistance (e.g., rent,
utility)
What would you recommend to improve the lives
of people living with HIV?
How well do our prevention services meet your
needs?
What would you like to see agencies do different.
Thank the participants for their time and remind
them to pick up their gift card before leaving.
125
APPENDIX 3: RESOURCE INVENTORY
FY 2015 Ryan White Part A/MAI Service Providers
Adult Special Care Center
877 Jefferson Avenue
Memphis, TN 38103
901-545-8481
2861 Broad Avenue, 38112
3124 North Thomas St., 38127
3362 South Third St., 38109
2569 Douglass Avenue, 38114
5366 Winchester Road, 38115
Memphis, TN
Medical Appt. Line
901-271-6000
Cocaine Alcohol Awareness
Program
4041 Knight Arnold Road, Suite 300
Memphis, TN 38118
901-261-7505
Community Services Agency (CSA)
Lipscomb-Pitts Building
2670 Union Extended, Suite 500
Memphis, TN 38112
901-222-4236
AIDS Pharmaceutical Assistance (Local)
Early Intervention Services
Medical Case Management
Medical Nutrition Therapy
Medical Transportation
Mental Health
Outpatient/Ambulatory Health
Food Bank/Vouchers
Emergency Financial Assistance
Dental
Food Bank/Vouchers
Mental Health
Substance Abuse Treatment (Outpatient)
Housing Assistance
126
East Arkansas Family Health
Center
620 Thompson Street
West Memphis, AR. 72301
870-735-3291
Friends for Life Corp
43 North Cleveland Avenue
Memphis, TN 38104
901-272-0855
Dental
Food Bank/Vouchers
Dental
Food Bank/Vouchers
Health Insurance Premium & Cost Sharing Assistance
Outreach Services
Hope House
23 South Idlewild
Memphis, TN 38104
901-272-2702
Psychosocial Support
Le Bonheur
50 Peabody Place
Memphis, TN 38103
901-287-5858
901-287-4764
Outreach Services
Memphis Gay and Lesbian
Community Center
892 South Cooper Street
Memphis, TN 38104
901-278-6422
360 EH Crump Blvd.
Memphis, TN 38126
901-261-2005
Outreach Services
901-679-6090
Dental
Early Intervention Services (EIS)
127
Resurrection Health Center
4095 American Way Suite 1
Memphis, TN 38118
901-271-9500
6050 Highway 161 North
Walls, MS 38680
662-342-3176
St. Jude Children’s Research
Hospital
262 Danny Thomas Place
Memphis, TN 38105
901-595-3669
Food Bank/Vouchers
814 Jefferson
Memphis, TN 38105
901-222-9425
1567 Overton Park
Memphis, TN. 38112
901-522-3401
Agency
Arkansas Cares/Methodist Family
Health
Baby Love
CAAP, Inc. (Cocaine and Alcohol
Awareness Program)
Case Management Inc.
Dozier House
Foundations Associates
Grace House
Harbor House Incorporated
JB Summers Counseling Center
Lakeside
Memphis Recovery Center
Moriah House
Serenity Recovery Center
Ultimate Solutions, Open Minds
Mental Health
Mental Health
Substance Abuse Treatment (Outpatient)
Alcohol and Drug Rehab – Inpatient
City, State
Telephone
Little Rock, AR
501-661-0720
Memphis, TN
901-271-5348
Memphis, TN
901-367-7550
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Somerville, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
901-821-5600
901-278-2367
901-969-5538
901-722-8460
901-743-1836
901-465-9831
800-232-5253
901-272-7751
901-522-8819
901-521-1131
901-324-0686
128
Agency
Health
Baby Love
Awareness Program)
Dozier House
Grace House
Lakeside
Moriah House
Synergy Foundation
Alcohol and Drug Rehab – Outpatient
City, State
Telephone
Little Rock, AR
501-661-0720
Memphis, TN
901-271-5348
Memphis, TN
901-367-7550
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Somerville, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
901-278-2367
901-969-5538
901-722-8460
901-743-1836
901-465-9831
800-232-5253
901-272-7751
901-522-8819
901-521-1131
901-332-2227
Alcohol and Drug Rehab - Support Groups
Agency
City, State
Telephone
Little Rock, AR
501-661-0720
Health
Memphis, TN
901-271-5348
Baby Love
Memphis, TN
901-367-7550
Awareness Program)
Memphis, TN
901-821-5600
Memphis, TN
901-278-2367
Dozier House
Memphis, TN
901-969-5538
Memphis, TN
901-722-8460
Grace House
Memphis, TN
901-743-1836
Somerville, TN
901-465-9831
Memphis, TN
800-232-5253
Lakeside
Life Strategies of Arkansas
West Memphis, AR
870-702-7657
Memphis, TN
901-272-7751
Mississippi Boulevard Christian
Memphis, TN
901-729-6222
Church
Narcotics Anonymous (NA)
Memphis, TN
901-276-5483
Professional Care Services
Millington, TN
901-873-0305
Memphis, TN
901-521-1131
Memphis, TN
901-332-2227
Synergy Foundation
Memphis, TN
901-552-3754
Urban Family Ministries
129
Agency
Adult Special Care – The Regional
One Medical Center
Health
Arkansas Delta AIDS Consortia
(ADAC)
Arkansas Department of Health
Awareness Program)
CDC Clinic of West Tennessee
Regional Health Office
Children and Family Services
Center
Friends for Life
Grace House
Jefferson Comprehensive Care
System
Lakeside
LeBonheur Community Health and
Well-Being
Life Strategies of Arkansas
Magnolia Medical Clinic
Memphis Health Center, Inc.
Methodist Alliance Hospice
Mid-State Opportunities
Nashville Cares Heartline
Northeast Arkansas Regional AIDS
Network (NARAN)
Porter Leath Children Services
Renewal Place
Salvation Army
Shelby County Relative Caregiver
Program
Southaven Samaritans
Case Management
City, State
Telephone
Memphis, TN
901-545-7446
Little Rock, AR
501-661-0720
West Memphis, AR
871-735-3291
Little Rock, AR
501-661-2400
Memphis, TN
901-367-7550
Memphis, TN
901-821-5600
Jackson, TN
731-423-6600
Covington, TN
Memphis, TN
(901)476-2364
901-260-8500
West Memphis, AR
870-735-3291
Memphis, TN
Memphis, TN
Somerville, TN
901-272-0855
901-722-8460
901-465-9831
Pine Bluff, AR
870-543-2380
Memphis, TN
800-232-5253
Memphis, TN
901-287-4764
West Memphis, AR
Greenwood, MS
Memphis, TN
Memphis, TN
Memphis, TN
Olive Branch, MS
Nashville, TN
870-702-7657
601-459-1277
901261-2005
901-272-7751
901-516-7269
662-895-4153
800-845-4266
Jonesboro, AR
870-931-4448
Memphis, TN
Millington, TN
Memphis, TN
Walls, MS
Memphis, TN
Memphis, TN
Memphis, TN
901-577-2500
901-873-0305
901-260-9132
662-342-3176
901-729-8007
901-521-1131
901-222-9000
Memphis, TN
901-448-3133
Horn Lake, MS
662-393-6439
130
Southeast Mental Health Center
St. Jude Children’s Research
Hospital
TN Department of Health SNAP
Benefits
Tutwiler Clinic
University of Arkansas Medical
Sciences HIV/AIDS Program
Agency
Health
Hope House
Network (NARAN)
Program
South Memphis Alliance
Women Infants and Children
(WIC)
Agency
Bill Castle, DDs
Church Health Center
Memphis and Shelby County
Health Department
Mobile Ministry of Dental
Joe O’Neal, DDS
Regional Medical Center at
Memphis (Adult Special Care
Clinic)
University of Tennessee College of
Dentistry
Agency
Memphis, TN
901-353-5440
Memphis, TN
901-595-3669
Nashville, TN
615-313-4700
Tutwiler, MS
662-345-8334
Little Rock, AR
501-686-7000
Memphis, TN
901-552-3754
Daycare/Respite Care
City, State
Telephone
Little Rock, AR
501-661-0720
Little Rock, AR
Memphis, TN
Somerville, TN
501-661-2400
901-272-2702
901-465-9831
Jonesboro, AR
870-931-4448
Memphis, TN
901-448-3133
Memphis, TN
901-774-9582
Memphis, TN
901-222-9750
Dental
City, State
Memphis, TN
Memphis, TN
Memphis, TN
Greenwood, MS
Telephone
901-260-8500
901-685-5008
901-272-0003
601-459-1277
Memphis, TN
901-544-7552
Memphis, TN
Memphis, TN
Memphis, TN
901-775-2000
901-679-6090
901-276-7314
Memphis, TN
901-545-8481
Memphis, TN
901-448-6220
Educational Resources / GED Assistance
City, State
Telephone
Little Rock, AR
501-661-0720
131
Health
Bellevue Frayser Church
Awareness Program)
Friends for Life
Hope Works
Jefferson Comprehensive Care
System
Lowenstein House
Memphis Area Gay Youth
(MAGY)
Planned Parenthood Greater
Memphis Region
Neighborhood Christian Center
Pine Hill Community Center
Program
Synergy Foundation
Agency
Health
Baby Love
Friends for Life
Hope Works
National Minority AIDS Council
Synergy Foundation
Agency
Arkansas AIDS Foundation
(Support Services)
Little Rock, AR
Memphis, TN
Memphis, TN
501-661-2400
901-358-3391
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Somerville, TN
901-821-5600
901-272-0855
901-743-1836
901-272-3700
901-465-9831
Pine Bluff, AR
870-543-2380
Memphis, TN
Memphis, TN
901-274-5486
Memphis, TN
Memphis, TN
901-272-7751
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
901-881-6013
901-774-7950
901-577-2500
Memphis, TN
Memphis, TN
901-332-2227
901-552-3754
901-367-7550
901-335-6249
901-725-1717
901-448-3133
Employment Assistance/Programs
City, State
Telephone
Little Rock, Arkansas
501-661-0720
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Somerville, TN
Washington, DC
Memphis, TN
Memphis, TN
Memphis, TN
Food Pantry/Groceries
City, State
Little Rock, AR
901-511-0268
901-821-5600
901-272-0855
901-743-1836
901-272-3700
901-465-9831
202-483-6622
901-881-6013
901-332-2227
901-552-3754
Telephone
501-376-6299
132
Health
Baby Love
Bellevue Frayser Church
Center
Fayette Cares
First Baptist
First United Methodist
Friends for Life
Good Neighbor Love Center
Holy Trinity Community Church
Impact Ministries
Interfaith Council on Poverty in
Hernando
Memphis Inter-Faith Hospitality
Network (MIHN)
Mid-State Opportunity, Inc.
MIFA (Metropolitan Inter-Faith
Association)
Church
Network (NARAN)
Olive Branch Food Ministry
Salvation Army
Tipton Cares
Women Infants and Children
(WIC)
Agency
Health
Baby Love
Crowley Ridge Development
Corporation
Center
Little Rock, AR
501-661-0720
Memphis, TN
Memphis, TN
901-511-0268
901-358-3391
West Memphis, AR
870-735-3291
Somerville, TN
Millington, TN
Memphis, TN
Memphis, TN
West Memphis, AR
Memphis, TN
Memphis, TN
901-465-3802
(901)872-2264
901-527-8362
901-272-0855
870-735-0870
901-320-9376
(901)358-3391
Hernando, MS
662-429-5789
Memphis, TN
901-452-6446
Olive Branch, MS
662-895-4153
Memphis, TN
901-527-0208
Memphis, TN
901-729-6222
Nashville, TN
Memphis, TN
800-845-4266
901-881-6013
870-931-4448
Jonesboro, AR
Olive Branch, MS
Walls, MS
Memphis, TN
Horn Lake, MS
Munford, TN
Memphis, TN
662-895-2913
662-342-3176
901-729-8007
662-393-6439
901-840-2273
901-552-3754
Memphis, TN
901-222-9750
City, State
Telephone
Little Rock, AR
501-661-0720
Memphis, TN
901-511-0268
Jonesboro, AR
870-935-8610
Memphis, TN
901-821-5600
West Memphis, AR
870-735-3291
133
Friends for Life
Network (MIHN)
Network (NARAN)
Salvation Army
Program
Tipton Cares
Agency
DeSoto County Health Department
Fayette County Health Department
Health Department
Tennessee Department of Health
Tipton County Health Department
Memphis, TN
Somerville, TN
Greenwood, MS
901-272-0855
901-465-9831
662-459-7000
Memphis, TN
901-452-6446
Nashville, TN
Memphis, TN
800-845-4266
901-881-6013
Jonesboro, AR
870-931-4448
Walls, MS
Memphis, TN
662-342-3176
901-729-8007
Memphis, TN
901-448-3133
Horn Lake, MS
Munford, TN
662-393-6439
901-840-2273
Health Departments
City, State
West Memphis, AR
Hernando, MS
Somerville, TN
Telephone
870-735-4334
662-429-9814
901-465-5243
Memphis, TN
901-222-9000
Nashville, TN
Covington, TN
800-525-2437
901-476-0235
HIV and STD Information and Resources
Agency
City, State
Telephone
Memphis, TN
901-545-7446
Medical Center
AIDSinfo
www.aidsinfoonline.org
Arkansas AIDS Foundation
Little Rock, AR
501-376-6299
Arkansas Delta AIDS Consortium
West Memphis, AR
870-735-3291
(ADAC)
West Memphis, AR
870-735-4334
Jackson, TN
731-423-6600
Children and Family Services
Covington, TN
(901)476-2364
Christ Community Health Services Memphis, TN
901-260-8500
Crittenden County Health
Earle, AR
870-792-7393
Department
DeSoto County Health Department Hernando, MS
662-429-9814
West Memphis, AR
870-735-3291
Center
Fayette County Health Department Somerville, TN
901-465-5243
134
Friends for Life
Shelby County Health Loop
HIV/AIDS Nightline
HIV/AIDS/STD - Branch of the
Le Bonheur Children’s Medical
Center (Infectious Disease Clinic –
Outpatient Ambulatory Clinic)
Well-Being
LINC - Memphis Library
Community Resource Database
Marshall County Health
Department
(MAGY)
(Choices) Memphis Center for
Reproductive Health
Community Center (MGLCC)
Memphis Region
Memphis Sexual Assault Resource
Center (MSARC)
Mid-South AIDS Fund
Mid-South Coalition on HIV/AIDS
(United Way of the Mid-South)
Mississippi Department of Health
Shelby County AIDS Hotline
Suicide and Crisis Intervention
Hotline
Tate County Health Department
Tunica County Health Department
Agency
Friends for Life
Le Bonheur Community Health and
Well-Being
Memphis Region
Memphis, TN
Memphis, TN
Nationwide
901-272-0855
901-222-9000
800-682-9240
Nashville, TN
615-741-7500
Memphis, TN
901-287-5437
Memphis, TN
Memphis, TN
http://www.memphislibrary.org/linc/
211.htm
Holly Springs, MS
662-252-4621
Memphis, TN
901-335-MAGY (6249)
Memphis, TN
901-274-3550
Memphis, TN
901-274-6422
Memphis, TN
901-261-2000
Memphis, TN
901-725-1717
Memphis, TN
901-222-4350
Memphis, TN
http://www.midsouthaidsfund.org/
Memphis, TN
www.uwmidsouth.org
Jackson, MS
Memphis, TN
Memphis, TN
Memphis, TN
866-HLTHY4UMS.com
800-448-0440
901-222-9000
901-774-9582
Memphis, TN
800-273-8255
Senatobia, MS
Covington, TN
Tunica, MS
662-562-4428
901-476-0235
662-363-2166
HIV Prevention Services
City, State
Memphis, TN
Telephone
901-272-0955
Memphis, TN
901-287-4764
Memphis, TN
901-725-1717
135
Partnership to End AIDS Status,
Inc (PEAS Inc)
Agency
Medical Center
Bisson Health Loop
Crittenden County Health
Department
DeSoto County Health Department
DeSoto Family Counseling Center
Center
Fayette County Health Department
Friends for Life
Health Loop
Well-Being
Marshall County Health
Department
(MAGY)
Community Center (MGLCC)
Memphis Regional Planned
Parenthood
Memphis Sexual Assault Resource
Center (MSARC)
New Directions Outreach Office
Partnership to End AIDS Status,
Inc (PEAS Inc)
Tate County Health Department
Tunica County Health Department
Agency
Crossroads Hospice
Hospice South
Memphis, TN
901-315-3316
HIV Testing Services
City, State
Telephone
Memphis, TN
901-545-7446
Memphis, TN
Memphis, TN
901-515-5500
901-260-8500
Earle, AR
870-792-7393
Hernando, MS
Southaven, MS
662-429-9814
662-342-2700
West Memphis, AR
870-735-3291
Somerville, TN
Memphis, TN
Memphis, TN
901-465-5243
901-272-0855
901-222-9000
Memphis, TN
901-287-4764
Holly Springs, MS
662-252-4621
Memphis, TN
901-335-MAGY (6249)
Memphis, TN
901-274-6422
Memphis, TN
901-261-2000
Memphis, TN
901-725-1717
Memphis, TN
901-222-4350
Memphis, TN
901-433-3871
Memphis, TN
901-315-3316
Memphis, TN
Memphis, TN
Senatobia, MS
Covington, TN
Tunica, MS
901-222-9000
901-774-9582
662-562-4428
901-476-0235
662-363-2166
Home Health
City, State
Memphis, TN
901-382-9292
Bartlett, TN
901-385-2221
Memphis, TN
901-222-9000
Telephone
136
Health Department
Regional Medical Center at
Memphis (Adult Special Care
Clinic)
Trinity Home Health and Hospice
Visiting Nurses Association
Agency
Arkansas AIDS Foundation (Support
Services)
Health
Awareness Program)
Ecumenical Village
First Congregational Church (First
Congo)
Friends for Life
HIV/AIDS/STD Branch of the
Hospitality HUB
Network (MIHN)
Association)
Moriah House
Network (NARAN)
Peabody House
Project Safe Place
Renewal Place
Salvation Army
Shelby County Housing Authority
Memphis, TN
901-680-0169
Memphis, TN
901-545-8481
Memphis, TN
Memphis, TN
901-762-6767
901-385-7787
Housing
City, State
Telephone
Little Rock, AR
501-376-6299
Little Rock, AR
501-661-0720
Memphis, TN
901-361-7550
Memphis, TN
901-821-5600
Jackson, TN
731-423-6600
West Memphis, AR
870-735-1115
Memphis, TN
901-278-6786
Memphis, TN
Memphis, TN
Memphis, TN
901-527-8362
901-272-0855
901-743-1836
Nashville, TN
615-741-7500
Memphis, TN
Somerville, TN
Greenwood, MS
901-522-1808
901-465-9831
662-459-1207
Memphis, TN
901-452-6446
Memphis, TN
901-272-7751
Memphis, TN
901-452-6446
Memphis, TN
Nashville, TN
901-522-8819
800-845-4266
Jonesboro, AR
870-931-4448
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
901-529-4000
901-577-2500
901-276-7233
901-543-8586
901-543-8586
901-544-1363
137
Southeast Community Mental Health
Center – Housing Developer
Tutwiler Clinic
YWCA of Greater Memphis, Crisis
Shelter
Agency
Community Legal Center
East Arkansas Legal Services
Memphis Area Legal Services
Memphis Lesbian and Gay Coalition
for Justice
Positive Living Center
Program
Agency
Medical Center
Health
Baby Love
Church Health Center Hope and
Healing Center
Church Health Center Medical Clinic
Delta Regional AIDS Education
Training Center
Health Loop
Infectious Disease Associates
Jefferson Comprehensive Care System
Lakeside Behavioral Health
Le Bonheur Center for Children and
Parents (CCP)
Horn Lake, MS
662-393-6439
Memphis, TN
866-791-9225
Tutwiler, MS
Memphis, TN
662-345-8334
901-552-3754
Memphis, TN
800-799-SAFE
Legal Services
City, State
Memphis, TN
901-543-3395
West Memphis, AR
870-732-6370
Memphis, TN
901-523-8822
Memphis, TN
901-327-2677
Memphis, TN
901-247-8321
Memphis, TN
901-448-7097
Medical Care
City, State
Telephone
Telephone
Memphis, TN
901-545-7446
Little Rock, AR
501-661-0720
Memphis, TN
Memphis, TN
901-511-0268
901-821-5600
Jackson, TN
731-423-6600
Memphis, TN
901-260-8500
Memphis, TN
901-259-4673
Memphis, TN
901-272-0003
Jackson, MS
http://www.deltaaetc.org/
West Memphis, AR
Memphis, TN
Memphis, TN
Somerville, TN
Pine Bluff, AR
Memphis, TN
870-735-3291
901-222-9000
901-685-3490
901-465-9831
870-543-2380
800-232-5253
Memphis, TN
901-287-4764
Greenwood, MS
Memphis, TN
662-459-1207
901-222-9000
138
(Choices) Memphis Center for
Reproductive Health
Network (NARAN)
Peabody Healthcare Group
Rossville Health Center
Trinity Home Health and Hospice
Tutwiler Clinic
University of Tennessee, OB/GYN
Clinic
White River Rural Health Center
Agency
Health
Baby Love
Genesis House
Lakeside
Parents (CCP)
Life Strategies
Whitehaven Southwest Mental Health
Center
Youth Villages
Agency
Medical Center
Health
Baby Love
DeSoto Behavioral Health
Memphis, TN
901-274-3550
Memphis, TN
Memphis, TN
Memphis, TN
901-261-2000
901-272-7751
901-516-1600
Jonesboro, AR
870-931-4448
Memphis, TN
Rossville, TN
Memphis, TN
Covington, TN
Memphis, TN
Tutwiler, MS
901-516-9830
901-261-7303
901-595-3300
901-476-0236
901-767-6767
662-345-8334
Little Rock, AR
501-686-7000
Memphis, TN
(901)448-4795
Augusta, AR
(870)347-33305
Mental Health – Inpatient
City, State
Telephone
Little Rock, AR
501-661-0720
Memphis, TN
Memphis, TN
901-511-0268
901-821-5600
Somerville, TN
Memphis, TN
901-465-9831
800-232-5253
Memphis, TN
901-287-4764
West Memphis, AR
Memphis, TN
(870)732-1878/(870)702-7657/(870)394-9577
901-272-7751
Memphis, TN
(901)259-1920
Memphis, TN
(901)252-7980
Mental Health – Outpatient
City, State
Memphis, TN
901-545-7446
Little Rock, AR
501-661-0720
Memphis, TN
Memphis, TN
Southaven, MS
901-511-0268
901-821-5600
(662)349-6658
Telephone
139
DeSoto Family Counseling Center
Family Counseling Services of
Millington
Frayser Family Counseling
Center/Comprehensive Counseling
Network
JB Summers Center
Lakeside
Parents (CCP)
Life Strategies
The Church On the Square
Center
Southaven, MS
West Memphis, AR
(662)342-2700
870-735-3291
Millington, TN
(901)881-6171
Memphis, TN
(901)353-5440
Somerville, TN
Memphis, TN
(901)465-9831
800-232-5253
Memphis, TN
800-232-5253
West Memphis, AR
Covington, TN
Southaven, MS
Memphis, TN
Memphis, TN
(870)732-1878
(901)476-8967
(662)393-6439
(901)369-1400
901-729-7907
Memphis, TN
(901)259-1920
Mental Health Outpatient / Group Counseling
Agency
City, State
Telephone
Little Rock, AR
501-661-0720
Health
Little Rock, AR
(501)561-2000
Baby Love
Memphis, TN
(901)577-0200 ext. 370
Memphis, TN
(901)821-5200
Church on the Square
Memphis, TN
(901)552-3431
West Memphis, AR
(870)735-3291
Millington, TN
(901)881-6171
Millington
JB Summers Center
Somerville, TN
(901)465-9831
Lakeside
Memphis, TN
800-232-5253
Life Strategies
West Memphis, AR
(870)732-1878
Lowenstein House
Memphis, TN
(901)274-5486
Memphis, TN
(901)272-7751
Parents, Family and Friends of
Memphis, TN
(870)514-0185
Lesbians and Gays (PFLAG)
Covington, TN
(901)476-8967
Southaven, MS
(662)393-6439
Memphis, TN
(901)369-1400
Mental Health Outpatient /Individual Counseling
Agency
City, State
Telephone
Little Rock, AR
501-661-0720
Health
140
Baby Love
Church on the Square
Millington
Frayser Family Counseling
Center/Comprehensive Counseling
Network
Hospitality HUB
JB Summers Center
Lakeside
Life Strategies
Center
Agency
Medical Center
(ADAC)
Baby Love
of Shelby County
Delta Regional AIDS Education
Training Center
Glaxo Smith Kline
HIV/AIDS/STD Branch of the
JB Summers Center
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
(901)577-0200 ext. 370
(901)821-5200
901-260-8500
(901)552-3431
Millington, TN
(901)881-6171
Memphis, TN
(901)353-5440
Nashville, TN
Memphis, TN
Somerville, TN
Memphis, TN
West Memphis, AR
Memphis, TN
Covington, TN
Southaven, MS
Memphis, TN
(615)352-3838
(901)522-1808
(901)465-9831
800-232-5253
(870)732-1878
(901)272-7751
(901)476-8967
(662)393-6439
(901)595-3669
Memphis, TN
(901)259-1920
Prescription Assistance
City, State
Telephone
Memphis, TN
(901)545-6925
West Memphis, AR
(870)735-3291
Little Rock, AR
Memphis, TN
Memphis, TN
(501)661-2000
(901)577-0200 ext. 370
(901)821-5200
Jackson, TN
(731)423-6600
Memphis, TN
(901)222-4200
Jackson, MS
(601)984-5542
West Memphis, AR
Jackson, TN
Memphis, TN
(870)735-3842
(731)422-4002
(901)948-3372
Nashville, TN
(615)741-7500
Somerville, TN
Greenwood, MS
Memphis, TN
Memphis, TN
(901)465-9831
662-459-1207
(901)261-2000
(901)272-7751
141
Planned Parenthood Greater Memphis
Region
Merck Pharmaceuticals
Network (NARAN)
Pfizer Pharmaceuticals/Agouron
Division
Agency
Services)
Health
Baby Love
of Shelby County
Fayette Cares
Friends for Life
Helping People With AIDS
JB Summers Center
Network (MIHN)
Association)
Network (NARAN)
Tipton Cares
Agency
Health
Baby Love
Church Health Center Hope and
Healing Center
Memphis, TN
(901)725-1717
Memphis, TN
Nashville, TN
(901)320-2011
(615)259-4866
Jonesboro, AR
(870)931-4448
La Jolla, CA
(858)622-3000
Memphis, TN
(901)595-3669
Rent Assistance
City, State
Telephone
Little Rock, AR
(501)376-6299
Little Rock, AR
(501)661-0720
Memphis, TN
Memphis, TN
(901)577-0200 ext. 370
(901)821-5200
Memphis, TN
(901)222-4200
Somerville, TN
Jackson, TN
Memphis, TN
Little Rock, AR
Somerville, TN
Greenwood, MS
(901)465-3802
(731)422-4002
(901)272-0855
(501)666-6900
(901)465-9831
662-459-1207
Memphis, TN
(901)452-6446
Charleston, MS
(662)647-2463
Memphis, TN
(901)527-0208
Nashville, TN
Memphis, TN
(615)259-4866
(901)881-6013/(901)745-1369
Jonesboro, AR
(870)931-4448
Munford, TN
Memphis, TN
(901)840-2273
(901)323-8400
Spiritual Services
City, State
Telephone
Little Rock, AR
(501)661-0720
Memphis, TN
(901)577-0200 ext. 370
Memphis, TN
(901)272-0003
142
Confidential Care for Women
(formerly Heart to Heart)
First Baptist
First Congregational Church (First
Congo)
Hospitality HUB
Well-Being
Church
Moriah House
St. Andrew AME Church
Urban Youth Initiative
Agency
Medical Center
Alcoholics Anonymous (AA)
Area Health Education Center
(AHEC)
Health
(ADAC)
Baby Love
Confidential Care for Women
(formerly Heart to Heart)
Millington
Friends for Life
Girls Inc.
Hope House
JB Summers Center
Millington, TN
(901)873-2273
Millington, TN
(901)872-2264
Memphis, TN
(901)278-6786
Nashville, TN
Memphis, TN
(615)352-3838
(901)522-1808
Memphis, TN
901-287-4764
Memphis, TN
Memphis, TN
(901)272-7751
(901)516-1600
Memphis, TN
(901)729-6222
Memphis, TN
Memphis, TN
Memphis, TN
Southaven, MS
Memphis, TN
Memphis, TN
Memphis, TN
Memphis, TN
(901)522-8819
(901)881-6013/(901)745-1369
(901)433-3871
(662)393-6439
(901)948-3441
(901)595-3669
(901)323-8400
(901)729-3988
Support Groups
City, State
Telephone
Memphis, TN
(901)545-8481
Memphis, TN
(901)454-1414
Pine Bluff, AR
(870)541-7611
Little Rock, AR
(501)661-0720
West Memphis, AR
(870)735-3291
Little Rock, AR
Memphis, TN
Memphis, TN
(501)561-2000
(901)577-0200
(901)821-5200
Millington, TN
(901)873-2273
Millington, TN
(901)362=0450
Memphis, TN
Memphis, TN
Nashville, TN
Memphis, TN
Somerville, TN
(901)272-0855
(901)527-4475
(615)352-3838
(901)-272-2702
(901)465-9831
143
Moriah House
Network (NARAN)
Salvation Army
Program
Synergy Foundation
Tennessee Department of Health (food
stamps)
Center
Women Infants and Children (WIC)
Agency
Medical Center
Services)
Arkansas Medicaid Transportation
Help-Line
Baby Love
Case Management, Inc
Awareness Program)
Delta Transportation
Friends for Life
Good Neighbor Center
Hospitality HUB
Jefferson Comprehensive Care System
Life Strategies
Lowenstein House
Network (MIHN)
Memphis, TN
Memphis, TN
Nashville, TN
Memphis, TN
(901)272-7751
(901)522-8819
(615)259-4866
(901)433-3871
Jonesboro, AR
(870)931-4448
Memphis, TN
(901)543-8586
Memphis, TN
(901)448-3133
Southaven, MS
Memphis, TN
Memphis, TN
(662)393-6439
(901)774-9582
(901)376-6299
Nashville, TN
(615)741-3111
Memphis, TN
(901)259-1920
Memphis, TN
901-222-9750
Transportation
City, State
Telephone
Memphis, TN
(901)545-8481
Little Rock, AR
(501)376-6299
Nashville, AR
(881)987-1200
Memphis, TN
Memphis, TN
901)577-0200 ext. 370
(901)821-5600
Memphis, TN
(901)261-7505
Memphis, TN
Covington, TN
West Memphis, AR
Memphis, TN
West Memphis, AR
Memphis, TN
Memphis, TN
Pine Bluff, AR
West Memphis, AR
Memphis, TN
Greenwood, MS
901-260-8500
(901)475-1269
870-735-3291
901-272-0855
(870)735-3291
901-743-1836
(901)522-1808
(870)535-3062
(870)732-1878/(870)702-7657/(870)394-9577
(901)274-5486
662-459-1207
Memphis, TN
(901)452-6446
Memphis, TN
Nashville, TN
(901)272-7751
(615)259-4866
144
Network (NARAN)
Synergy Foundation
TennCare Transportation
Tutwiler Clinic
Agency
Services)
Baby Love
of Shelby County
Fayette Cares
Friends for Life
Good Neighbor Center
Helping People With AIDS
Network (MIHN)
Association)
Network (NARAN)
Salvation Army
Jonesboro, AR
(870)931-4448
Memphis, TN
Memphis, TN
(901)595-3669
(901)274-7052
Tutwiler, MS
(662)345-8334
Little Rock, AR
(501)686-7000
Memphis, TN
(901)323-8400
Utility Assistance
City, State
Telephone
Little Rock, AR
(501)376-6299
Memphis, TN
Memphis, TN
(901)577-0200 ext. 370
(901)821-5600
Memphis, TN
(901)222-4200
Somerville, TN
Jackson, TN
Memphis, TN
West Memphis, AR
Little Rock, AR
(901)465-3802
(731)422-4002
(901)272-0855
(870)735-0870
(501)666-6900
Memphis, TN
(901)527-0208
Charleston, MS
(662)647-2463
Memphis, TN
(901)527-0208
Nashville, TN
Memphis, TN
(615)259-4866
(901)881-6013/(901)745-1369
Jonesboro, AR
(870)931-4448
Memphis, TN
Southaven, MS
Covington, TN
Memphis, TN
(901)543-8586
(662)393-6439
(901)476-0235
(901)323-8400
145
APPENDIX 4: PROVIDER SURVEY
146
2015 Provider Needs Assessment
HIV Provider Participation
2015 Comprehensive Needs Assessment
You are being requested to participate in a comprehensive needs assessment survey for people living with HIV/AIDS. This study is
being conducted by The Ryan White HIV/AIDS Program. By responding to the survey question, you are assisting the HIV-Care and
Prevention Group set funding priorities and plan for future service needs in the Memphis Transitional Grant Area.
All information provided will be kept confidential. Survey results will not be released or reported in any way that might allow for
identification of individual participants, and in no case will responses from individual participants be identified. No one will be able to
determine your association with any service provider.
Your participation in the survey typically takes 5-10 minutes. The questions are for you to share any thoughts, opinions and attitudes
your have relative to gaps in services for individuals living with HIV.
There are no potential risks associated with your participation in this survey and there are no costs associated with your participation.
If you have any questions, please contact Nycole Alston, Planning Group Manager, Shelby County Government, Ryan White Part A
Program, (901)222.8283 [email protected].
Provider Service Input
* Which Ryan White Part A Service Provider do you work for?
Adult Special Care Clinic
Cocaine and Alcohol Awareness Program, Inc.
Crisis Center
Community Services Agency
Friends for Life
Hope House
Le Bonheur
Memphis Gay and Lesbian Community Center
Resurrection Health
St Jude
UT Medical Group Inc.
* How long have you been providing care for PLWHA (People Living With HIV or AIDS)?
Less than 1 month
Less than 6 months
6-12 months
1-2 years
2-3 years
3-4 years
4-5 years
5-6 years
6 or more years
* What is your primary role at your organization?
Medical Case Manager
Non-Medical Case Manager
Early Intervention Specialist
Physician
Nurse
Social Worker
Psychologist
Psychiatrist
* Are there services that you currently need more of or don’t have that would allow you to better serve your
clients/patients?
No
Yes (please explain)
* Do you feel that Ryan White Part A programming is sufficient and meets the needs of these populations?
Yes
No
Not Sure
African Americans
Latinos/Hispanics
MSM (Men who have
sex with men)
Women of childbearing
age
Youth
Formerly incarcerated
individuals
People with substance
abuse treatment needs
People with need for
dental/oral health
services
Undocumented
immigrants & Spanishspeaking clients
Transgender
Homeless
Seniors/Elderly
* What do you feel are the most effective methods your agency uses to retain clients in care?
Outreach strategies
Cultural competence
High level of interest staff take in consumers' lives and care
Caring relationship
* What do you feel are the most effective methods your organization uses to identify PLWHA and bring them
into care?
Outreach strategies
Cultural competence
High level of interest staff take in consumers' lives and care
Social network testing
* The goal of Ryan White providers is that they should understand and respect consumers as personsincluding the parts of them that make them the unique person who they are, even if those things are very
different from the provider.
Do you feel that you, as a provider, understand Ryan White clients regarding these following ways they are
unique and consistently treat them in a manner appropriate to that uniqueness?
Agree
Age
Race
The people they are
attracted to and have sex
with
The gender they express
The amount of money
they have
The type of job they
have
Who they live with
The type of place they
live in
The community they're
from
Their language, if it's not
English
Their educational level
address them and talk to
them
Their religious beliefs or
Their HIV status
Other illnesses, including
mental illnesses, that
they have
Neither agree nor disagree
Disagree
* Which of the following do you feel would most help you to better serve your clients/PLWHA? Mark all that
apply.
Training on how to better advocate for clients/patients
HIV care related training surrounding antiretroviral therapy, managing opportunistic infections, or monitoring/explaining a patient’s
health status
Training to provide more efficient services
Faster appointment scheduling
Less wait time for clients during visits
Transportation
Additional opportunities to share information between providers
Evening hours
Weekend hours
Training to enhance cultural competency
* Which of the following would you feel would make the most impact as a system-wide change, other than
funding, to improve services for all PLWHA. Or, add your own answer.
A better understanding of the people my organization serves
More effective strategies to retain consumers in care
More education for consumers on managing their illness
More current education for providers on treating HIV
More provider locations
Better ways to get consumers to care
Training about resources available to help PLHWA in this area
* Select the biggest barrier, other than funding, that your organization experiences when providing care to
PLWHA. Or, add your own answer.
A lack of a good understanding of the people my organization serves
Few effective strategies to retain consumers in care
Little education for consumers on managing their illness
Providers don't seem current on HIV treatment
Inconvenient hours or inaccessible provider locations
We lack ways to get consumers to care (transportation)
Too many consumers for the staff we have
Consumers don't care about their HIV treatment
Staff doesn't know about resources available for PLWHA in this area
* Rate your knowledge of the following.
Know all about it; I
refer regularly
ARTAS
SMILE program
Social Networking
Strategies
CLEAR
freecondomsmemphis.org
3MV
TWISTA
Provider Demographics
I know about it
some; I have
referred some
Don't know much
about it; I've
referred at least
once
I've heard about it,
but never referred
Never heard about
it
* Which of the following age groups are you in?
13-24
25-44
45-64
65 or older
* Do you think of yourself as (please check all that apply):
Straight
Gay or lesbian
Bisexual
* What sex were you assigned at birth, on your original birth certificate?
Male
Female
* How do you describe yourself? (check one)
Male
Female
Transgender, transsexual, or gender non-conforming
I do not identify as any of these.
Transgender specification
Transgender or transsexual, male to female
Transgender or transsexual, female to male
Gender non-conforming
Hispanic Ethnicity
* Are you Hispanic?
Yes
No
Hispanic Ethnicity Specification
Mexican, Mexican American, Chicano/o
Puerto Rican
Cuban
Another Hispanic, Latino/a, or Spanish origin
Race
* What is your race? (check all that apply)
White/Caucasian
Asian
Asian Ethnicity Specification
* If you are Asian, which best describes you?
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiian or Pacific Islander Ethnicity Specification
* If you are Native Hawaiian or Pacific Islander, which best describes you?
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Core Services Utilization
* What services does your agency provide to adults living with HIV? (check all that apply)
Medical care (Outpatient and ambulatory medical care)
AIDS drug assistance program
AIDS pharmaceutical assistance
Oral health
Health insurance premium and cost-sharing assistance for low-income individuals
Hospice services
Home and community-based health services
Substance abuse outpatient care
Home health care
Medical case management, including treatment adherence services
Support Services Utilization
* What services does your agency provide to adults living with HIV? (check all that apply)
Child care services
Food bank/home-delivered meals
Housing services
Legal services
Linguistics services (interpretation and translation)
Outreach services
Referral for health care/supportive services
Respite care
Substance abuse services—residential
Treatment adherence counseling
End of survey
* Overall, did you think this survey was:
Too long, but covered all the information
Too long, and I did not want to finish it
Too short, there were more things you could have asked
Just right
Is there anything else you'd like for us to know?
* Would you like to answer two OPTIONAL questions about your feelings regarding preventing the spread of
HIV in the Memphis area?
Yes
No
Optional Questions
* What one strategy do you feel would BE MOST EFFECTIVE in preventing the spread of HIV in the
* What one strategy do you feel would BE LEAST EFFECTIVE in preventing the spread of HIV in the

The 2015 Comprehensive Needs Assessment Memphis Transitional

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